Provider Demographics
NPI:1265622666
Name:SHAH, KEYUR ATUL (BS, DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KEYUR
Middle Name:ATUL
Last Name:SHAH
Suffix:
Gender:M
Credentials:BS, DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17409 STONE HILL DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8249
Mailing Address - Country:US
Mailing Address - Phone:708-945-1455
Mailing Address - Fax:
Practice Address - Street 1:10781 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-2313
Practice Address - Country:US
Practice Address - Phone:708-974-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics