MEDICARE: DR. MICHAEL SHAHAN GARRY JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019015937	IL
2	1223G0001X	General Practice Dentistry	019015937	IL

General Provider Information

NPI Number	:	1013913565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SHAHAN GARRY JR. DDS

Provider Business Mailing Address
First Line	:	1475 GLEN LAKE RD
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169
Country	:	US
Telephone Number	:	847-882-2620
Fax Number	:	847-882-0254

Provider Business Practice Location Address
First Line	:	1475 GLEN LAKE RD
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169
Country	:	US
Telephone Number	:	847-882-2620
Fax Number	:	847-882-0254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	10/25/2018

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