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General NPI Number Information
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NPI Number | 1396830394
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Entity Type | Organization
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Legal Business Name | EMAN SHIRAZI DDS PC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 2250 WEST ALGONQUIN ROAD STE 101
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156
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Country | US
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Telephone | 847-854-2970
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Fax | 847-854-3171
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Provider Business Mailing Address
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Address Line | 2250 WEST ALGONQUIN ROAD STE 101
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156
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Country | US
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Telephone | 847-854-2970
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Fax | 847-854-3171
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMAN A SHIRAZI
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Credential | DDS
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Telephone | 847-854-2970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19025647
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License Number State | IL
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