Provider Demographics
NPI:1295046118
Name:SHAH, LUCY PATEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:PATEL
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 NORTHWIND CIR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4419
Mailing Address - Country:US
Mailing Address - Phone:301-404-4489
Mailing Address - Fax:847-740-0397
Practice Address - Street 1:425 N. WILSON RD
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073
Practice Address - Country:US
Practice Address - Phone:847-740-0217
Practice Address - Fax:847-740-0397
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist