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General NPI Number Information
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NPI Number | 1134751837
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Entity Type | Organization
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Legal Business Name | SHAAN DENTAL LLC
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 5917 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4515
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Country | US
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Telephone | 708-439-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 15551 DEWBERRY LN
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City | ORLAND PARK
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State | IL
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Zip | 60462-7719
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Country | US
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Telephone | 708-745-2758
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SHAAN ANKOLA
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Credential | DMD
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Telephone | 708-745-2758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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