Provider Demographics
NPI:1053490383
Name:SHAH, REENA P (DDS)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:P
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:#64
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:312-573-4515
Mailing Address - Fax:312-573-8405
Practice Address - Street 1:467 W DEMING PL
Practice Address - Street 2:SUITE 900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1881
Practice Address - Country:US
Practice Address - Phone:773-327-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190251811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry