Provider Demographics
NPI:1700517273
Name:SHAKER, NAGUIB SAMER (DDS)
Entity Type:Individual
Prefix:
First Name:NAGUIB
Middle Name:SAMER
Last Name:SHAKER
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 1:3941 N KEELER AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2909
Mailing Address - Country:US
Mailing Address - Phone:405-397-6585
Mailing Address - Fax:
Practice Address - Street 1:4830 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2844
Practice Address - Country:US
Practice Address - Phone:773-694-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist