Provider Demographics
NPI:1245606680
Name:SHAKIR, FARAH (DMD)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:SHAKIR
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 1:6520 JOLIET RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4649
Mailing Address - Country:US
Mailing Address - Phone:708-354-4545
Mailing Address - Fax:
Practice Address - Street 1:2545 W PETERSON AVE
Practice Address - Street 2:201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659
Practice Address - Country:US
Practice Address - Phone:773-561-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319019572122300000X
IL019030348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist