Provider Demographics
NPI:1033586276
Name:GEORGE, SHEILA VARUGHESE (DMD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:VARUGHESE
Last Name:GEORGE
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 1:17W714 BUTTERFIELD RD
Mailing Address - Street 2:APT #303
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4361
Mailing Address - Country:US
Mailing Address - Phone:832-573-2480
Mailing Address - Fax:
Practice Address - Street 1:7640 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-2213
Practice Address - Country:US
Practice Address - Phone:630-830-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030414122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist