Provider Demographics
NPI:1093887366
Name:SHAH, SAYED HAROON B (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAYED HAROON
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GRAND CANYON PKWY
Mailing Address - Street 2:209
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60196-0001
Mailing Address - Country:US
Mailing Address - Phone:847-310-9816
Mailing Address - Fax:847-310-9817
Practice Address - Street 1:1000 GRAND CANYON PKWY
Practice Address - Street 2:209
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60196-0001
Practice Address - Country:US
Practice Address - Phone:847-310-9816
Practice Address - Fax:847-310-9817
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0261521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice