MEDICARE: MRUNAL SHAH DMD

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	1223G0001X	General Practice Dentistry	019.034300	IL

General Provider Information

NPI Number	:	1417639709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRUNAL SHAH DMD

Provider Business Mailing Address
First Line	:	1340 SAINT CLAIRE PL
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-6186
Country	:	US
Telephone Number	:	847-687-3395
Fax Number	:

Provider Business Practice Location Address
First Line	:	1177 BLOOMINGDALE RD STE B
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3402
Country	:	US
Telephone Number	:	630-866-6000
Fax Number	:

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

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	08/04/2023

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