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General NPI Number Information
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NPI Number | 1891328837
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Entity Type | Individual
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Provider Name | BANSARI SHAH B.D.S., M.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 2124 OGDEN AVENUE SUITE 104
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City | AURORA
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State | IL
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Zip | 60504
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Country | US
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Telephone | 630-585-6100
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Fax | 630-778-2070
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Provider Business Mailing Address
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Address Line | 2124 OGDEN AVENUE SUITE 104
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City | AURORA
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State | IL
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Zip | 60504
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Country | US
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Telephone | 630-585-6100
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Fax | 630-778-2070
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021.003210
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 10355
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License Number State | KY
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