Provider Demographics
NPI:1972156123
Name:SHUBINETS, VASYL (DMD)
Entity Type:Individual
Prefix:
First Name:VASYL
Middle Name:
Last Name:SHUBINETS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W TALCOTT RD # 24
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5556
Mailing Address - Country:US
Mailing Address - Phone:847-720-4502
Mailing Address - Fax:847-720-4636
Practice Address - Street 1:2 W TALCOTT RD # 24
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5556
Practice Address - Country:US
Practice Address - Phone:847-720-4502
Practice Address - Fax:847-720-4636
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN243581223G0001X
IL019.0321361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice