MEDICARE: MATTHEW JAMES MCSHANE 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	019.031164	IL

General Provider Information

NPI Number	:	1508307778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JAMES MCSHANE DMD

Provider Business Mailing Address
First Line	:	3340 N LAWNDALE AVE # 3N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5326
Country	:	US
Telephone Number	:	630-788-8374
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 BIESTERFIELD RD STE 104
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3393
Country	:	US
Telephone Number	:	847-437-8366
Fax Number	:

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	09/16/2021

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