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General NPI Number Information
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NPI Number | 1184538498
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Entity Type | Organization
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Legal Business Name | PARK RIDGE COMPLETE DENTAL PLLC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 912 BUSSE HWY
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City | PARK RIDGE
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State | IL
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Zip | 60068-2304
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Country | US
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Telephone | 929-655-9974
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Fax |
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Provider Business Mailing Address
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Address Line | 912 BUSSE HWY
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City | PARK RIDGE
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State | IL
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Zip | 60068-2304
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Country | US
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Telephone | 929-655-9974
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Fax |
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Authorized Official
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Title or Position | DDS, PERIODONTIST
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Name | DR. IBRAHIM SHUAIB
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Credential |
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Telephone | 929-655-9974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | NULL
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