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General NPI Number Information
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NPI Number | 1528435567
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Entity Type | Individual
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Provider Name | MUZAFFAR MOHAMMED SHAH-KHAN DDS, MPH
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Gender | Male
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 256 WOOD GLEN LN
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City | OAK BROOK
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State | IL
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Zip | 60523-1535
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Country | US
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Telephone | 630-745-7786
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Fax |
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Provider Business Mailing Address
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Address Line | 256 WOOD GLEN LN
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City | OAK BROOK
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State | IL
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Zip | 60523-1535
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Country | US
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Telephone | 630-745-7786
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Fax |
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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 | 019030459
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License Number State | IL
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