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1009 W Webster Ave Chicago IL 60614-3502 | |
| (872) 829-3280 | |
| (872) 829-3281 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1009 W Webster Ave, Chicago, Illinois |
| Authorized Official Name and Position | Brian Shah (PRESIDENT) |
| Authorized Official Contact | 3126596163 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1009 W Webster Ave Chicago IL 60614-3502 Ph: (872) 829-3280 | 1009 W Webster Ave Chicago IL 60614-3502 Ph: (872) 829-3280 |
| NPI Number | 1386070167 |
|---|---|
| Provider Enumeration Date | 09/24/2013 |
| Last Update Date | 09/24/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386070167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 019028191 (Illinois) | Primary |
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