Provider Demographics
NPI:1942843420
Name:SHAH, PALAK M (BDS)
Entity Type:Individual
Prefix:
First Name:PALAK
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 N. PLUM GROOVE RD
Mailing Address - Street 2:APT 214
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173
Mailing Address - Country:US
Mailing Address - Phone:424-522-4023
Mailing Address - Fax:
Practice Address - Street 1:1261 N LAKE ST STE J
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2471
Practice Address - Country:US
Practice Address - Phone:630-801-0002
Practice Address - Fax:630-801-0003
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist