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General NPI Number Information
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NPI Number | 1497759179
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Entity Type | Individual
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Provider Name | SHAFA AMIRSOLTANI DDS
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Gender | Female
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 185 N MARION ST APT 1
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City | OAK PARK
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State | IL
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Zip | 60301-1513
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Country | US
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Telephone | 708-383-3377
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Fax | 708-383-3779
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Provider Business Mailing Address
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Address Line | 185 N MARION ST APT 1
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City | OAK PARK
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State | IL
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Zip | 60301-1513
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Country | US
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Telephone | 708-383-3377
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Fax | 708-383-3779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019023196
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-023196
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License Number State | IL
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