MEDICARE: DR. DAVID CHARLES SHONBERG 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	019-017272	IL
2	1223P0700X	Prosthodontics	021-001956	IL

General Provider Information

NPI Number	:	1740386739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHARLES SHONBERG DDS

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1503
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-726-1901
Fax Number	:	312-377-5053

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1503
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-726-1901
Fax Number	:	312-377-5053

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	06/07/2019

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