Provider Demographics
NPI:1346810108
Name:SHUAIPAJ, NAIM (DMD)
Entity Type:Individual
Prefix:
First Name:NAIM
Middle Name:
Last Name:SHUAIPAJ
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 1:13800 SKENDER CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7219
Mailing Address - Country:US
Mailing Address - Phone:630-432-3825
Mailing Address - Fax:
Practice Address - Street 1:11808 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1608
Practice Address - Country:US
Practice Address - Phone:708-489-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist