Provider Demographics
NPI:1811228166
Name:HANOVER DENTAL PC
Entity Type:Organization
Organization Name:HANOVER DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-631-1790
Mailing Address - Street 1:7640 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-2213
Mailing Address - Country:US
Mailing Address - Phone:630-830-2000
Mailing Address - Fax:630-830-9500
Practice Address - Street 1:7640 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-2213
Practice Address - Country:US
Practice Address - Phone:630-830-2000
Practice Address - Fax:630-830-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty