Provider Demographics
NPI:1568917508
Name:DENTAL SHINE II P.C
Entity Type:Organization
Organization Name:DENTAL SHINE II P.C
Other - Org Name:APEX DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-MUQDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-769-1073
Mailing Address - Street 1:11830 S ROUTE 59
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5894
Mailing Address - Country:US
Mailing Address - Phone:815-609-0000
Mailing Address - Fax:
Practice Address - Street 1:11830 S ROUTE 59
Practice Address - Street 2:SUITE 110
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5894
Practice Address - Country:US
Practice Address - Phone:815-609-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL SHINE II P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty