Provider Demographics
NPI:1366288730
Name:SHABAN, NADEEN (DMD)
Entity type:Individual
Prefix:
First Name:NADEEN
Middle Name:
Last Name:SHABAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 W 157TH ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5822
Mailing Address - Country:US
Mailing Address - Phone:708-307-1984
Mailing Address - Fax:
Practice Address - Street 1:7805 W 157TH ST APT 1S
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-5822
Practice Address - Country:US
Practice Address - Phone:708-307-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0353041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice