Provider Demographics
NPI:1740386739
Name:SHONBERG, DAVID CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:SHONBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-726-1901
Mailing Address - Fax:312-377-5053
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-726-1901
Practice Address - Fax:312-377-5053
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-017272122300000X
IL021-0019561223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics