Provider Demographics
NPI:1114916129
Name:BADER, SHAFEEQ H (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAFEEQ
Middle Name:H
Last Name:BADER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CLOVER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-2892
Mailing Address - Country:US
Mailing Address - Phone:630-773-1781
Mailing Address - Fax:
Practice Address - Street 1:148 E ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1647
Practice Address - Country:US
Practice Address - Phone:224-698-1472
Practice Address - Fax:224-653-4878
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025521122300000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist