Healthcare Provider Details

I. General information

NPI: 1184538498
Provider Name (Legal Business Name): PARK RIDGE COMPLETE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 BUSSE HWY
PARK RIDGE IL
60068-2304
US

IV. Provider business mailing address

912 BUSSE HWY
PARK RIDGE IL
60068-2304
US

V. Phone/Fax

Practice location:
  • Phone: 929-655-9974
  • Fax:
Mailing address:
  • Phone: 929-655-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. IBRAHIM SHUAIB
Title or Position: DDS, PERIODONTIST
Credential:
Phone: 929-655-9974