Healthcare Provider Details

I. General information

NPI: 1194636316
Provider Name (Legal Business Name): STC DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 DEAN ST STE O2
ST CHARLES IL
60175-1067
US

IV. Provider business mailing address

2210 DEAN ST STE O2
ST CHARLES IL
60175-1067
US

V. Phone/Fax

Practice location:
  • Phone: 630-584-8787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ATISH SHAH
Title or Position: DENTIST
Credential: DMD
Phone: 847-942-5292