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General NPI Number Information
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NPI Number | 1952880684
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Entity Type | Individual
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Provider Name | SAMER SHALTONI DMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 1411 MCHENRY RD STE 127
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-1386
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Country | US
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Telephone | 847-276-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 709 STONE CANYON CIR
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City | INVERNESS
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State | IL
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Zip | 60010-6447
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019031154
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 021.003033
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License Number State | IL
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