Provider Demographics
NPI:1841920667
Name:SHAH, PRIYA ILESH (DDS)
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:ILESH
Last Name:SHAH
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 1:360 W HUBBARD ST APT 1809
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5752
Mailing Address - Country:US
Mailing Address - Phone:219-794-6333
Mailing Address - Fax:
Practice Address - Street 1:7942 W OAKTON ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2400
Practice Address - Country:US
Practice Address - Phone:847-823-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013814A122300000X
IL019.035046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist