Provider Demographics
NPI:1205993193
Name:SHUAIPAJ, MAZAR (DDS)
Entity type:Individual
Prefix:MR
First Name:MAZAR
Middle Name:
Last Name:SHUAIPAJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 FAIRVIEW AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2267
Mailing Address - Country:US
Mailing Address - Phone:630-968-8439
Mailing Address - Fax:630-968-7259
Practice Address - Street 1:4121 FAIRVIEW AVE
Practice Address - Street 2:STE 205
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2267
Practice Address - Country:US
Practice Address - Phone:630-968-8439
Practice Address - Fax:630-968-7259
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist