Provider Demographics
NPI:1841551595
Name:SHEBLAK, RANEEM R (DDS)
Entity type:Individual
Prefix:DR
First Name:RANEEM
Middle Name:R
Last Name:SHEBLAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 WESTERN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1398
Mailing Address - Country:US
Mailing Address - Phone:708-269-0284
Mailing Address - Fax:
Practice Address - Street 1:12200 WESTERN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1398
Practice Address - Country:US
Practice Address - Phone:708-385-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist