Provider Demographics
NPI:1669187845
Name:ADVANCED DENTAL CARE OF THE MIDWEST, LTD
Entity type:Organization
Organization Name:ADVANCED DENTAL CARE OF THE MIDWEST, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABANY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:314-755-1542
Mailing Address - Street 1:443 N NEW BALLAS RD STE 244
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6800
Mailing Address - Country:US
Mailing Address - Phone:314-755-1542
Mailing Address - Fax:
Practice Address - Street 1:443 N NEW BALLAS RD STE 244
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6800
Practice Address - Country:US
Practice Address - Phone:314-755-1542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental