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General NPI Number Information
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NPI Number | 1194636316
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Entity Type | Organization
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Legal Business Name | STC DENTAL PLLC
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 2210 DEAN ST STE O2
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City | ST CHARLES
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State | IL
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Zip | 60175-1067
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Country | US
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Telephone | 630-584-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 DEAN ST STE O2
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City | ST CHARLES
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State | IL
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Zip | 60175-1067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ATISH SHAH
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Credential | DMD
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Telephone | 847-942-5292
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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 |
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