Provider Demographics
NPI:1801054168
Name:KRUPALI SHAH DDS PC
Entity type:Organization
Organization Name:KRUPALI SHAH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRUPALI
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-407-1004
Mailing Address - Street 1:409 E EUCLID AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1214
Mailing Address - Country:US
Mailing Address - Phone:847-342-1999
Mailing Address - Fax:847-342-8990
Practice Address - Street 1:409 E EUCLID AVE
Practice Address - Street 2:UNIT B
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1214
Practice Address - Country:US
Practice Address - Phone:847-342-1999
Practice Address - Fax:847-342-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty