Provider Demographics
NPI:1881388031
Name:SHEEZAN, SHAIK (DMD)
Entity type:Individual
Prefix:
First Name:SHAIK
Middle Name:
Last Name:SHEEZAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2645
Mailing Address - Country:US
Mailing Address - Phone:331-425-0216
Mailing Address - Fax:
Practice Address - Street 1:415 LOCUST ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-3511
Practice Address - Country:US
Practice Address - Phone:815-625-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0343151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice