Provider Demographics
NPI:1609107010
Name:DIPAK S SHAH DDS LTD
Entity Type:Organization
Organization Name:DIPAK S SHAH DDS LTD
Other - Org Name:CENTRAL DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-652-7575
Mailing Address - Street 1:5539 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2218
Mailing Address - Country:US
Mailing Address - Phone:708-652-7575
Mailing Address - Fax:708-652-7545
Practice Address - Street 1:5539 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2218
Practice Address - Country:US
Practice Address - Phone:708-652-7575
Practice Address - Fax:708-652-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-015412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty