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General NPI Number Information
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NPI Number | 1508094145
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Entity Type | Organization
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Legal Business Name | DIPAK S. SHAH D.D.S. , LTD.
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 4118 N CASS AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1312
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Country | US
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Telephone | 630-852-4848
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Fax | 630-852-1941
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Provider Business Mailing Address
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Address Line | 4118 N CASS AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1312
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Country | US
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Telephone | 630-852-4848
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Fax | 630-852-1941
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIPAK S. SHAH
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Credential | DDS
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Telephone | 630-852-4848
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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 | 019015412
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License Number State | IL
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