Provider Demographics
NPI:1578624698
Name:SHAFI, REEM (DDS)
Entity Type:Individual
Prefix:
First Name:REEM
Middle Name:
Last Name:SHAFI
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 1:1137 N. EOLA RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-898-2688
Mailing Address - Fax:630-898-0017
Practice Address - Street 1:1137 N. EOLA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-898-2688
Practice Address - Fax:630-898-0017
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004872Medicaid