Provider Demographics
NPI:1447743836
Name:SHAHIN, BETTI (DMD, DPDS, MSC)
Entity Type:Individual
Prefix:DR
First Name:BETTI
Middle Name:
Last Name:SHAHIN
Suffix:
Gender:F
Credentials:DMD, DPDS, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 N KEDZIE AVE APT 1016
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-2728
Mailing Address - Country:US
Mailing Address - Phone:773-381-9637
Mailing Address - Fax:
Practice Address - Street 1:712 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6246
Practice Address - Country:US
Practice Address - Phone:773-783-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist