Provider Demographics
NPI:1710732938
Name:DHAVAL V SHAH DMD PC
Entity type:Organization
Organization Name:DHAVAL V SHAH DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHAVAL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-965-8133
Mailing Address - Street 1:16551 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4649
Mailing Address - Country:US
Mailing Address - Phone:630-965-8133
Mailing Address - Fax:
Practice Address - Street 1:310 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2363
Practice Address - Country:US
Practice Address - Phone:708-352-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty