Provider Demographics
NPI:1396830394
Name:EMAN SHIRAZI DDS PC
Entity Type:Organization
Organization Name:EMAN SHIRAZI DDS PC
Other - Org Name:WATERTOWER FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-854-2970
Mailing Address - Street 1:2250 WEST ALGONQUIN ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156
Mailing Address - Country:US
Mailing Address - Phone:847-854-2970
Mailing Address - Fax:847-854-3171
Practice Address - Street 1:2250 WEST ALGONQUIN ROAD
Practice Address - Street 2:STE 101
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156
Practice Address - Country:US
Practice Address - Phone:847-854-2970
Practice Address - Fax:847-854-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190256471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty