MEDICARE: DR. SHAFEEQ H BADER 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	019025521	IL
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	019025521	IL

General Provider Information

NPI Number	:	1114916129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAFEEQ H BADER DDS

Provider Business Mailing Address
First Line	:	830 CLOVER RIDGE CT
Second Line	:
City	:	ITASCA
State	:	IL
Zip	:	60143-2892
Country	:	US
Telephone Number	:	630-773-1781
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 E ARMY TRAIL RD
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1647
Country	:	US
Telephone Number	:	224-698-1472
Fax Number	:	224-653-4878

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/07/2023

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