Provider Demographics
NPI:1891328837
Name:SHAH, BANSARI (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:BANSARI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 OGDEN AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-585-6100
Mailing Address - Fax:630-778-2070
Practice Address - Street 1:2124 OGDEN AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-585-6100
Practice Address - Fax:630-778-2070
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0032101223P0300X
KY10355390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program