Provider Demographics
NPI:1801060421
Name:MARSHALL SHIKAMI DDS PC
Entity type:Organization
Organization Name:MARSHALL SHIKAMI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIKAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-754-1063
Mailing Address - Street 1:1526 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3523
Mailing Address - Country:US
Mailing Address - Phone:708-754-1063
Mailing Address - Fax:708-755-4696
Practice Address - Street 1:1526 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3523
Practice Address - Country:US
Practice Address - Phone:708-754-1063
Practice Address - Fax:708-755-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
IL019018895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty