Provider Demographics
NPI:1902966708
Name:SHEIKH, DILMUBARAK (DDS)
Entity Type:Individual
Prefix:
First Name:DILMUBARAK
Middle Name:
Last Name:SHEIKH
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 1:364 HIGHKNOB RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3268
Mailing Address - Country:US
Mailing Address - Phone:630-679-1334
Mailing Address - Fax:
Practice Address - Street 1:106 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3755
Practice Address - Country:US
Practice Address - Phone:708-615-0600
Practice Address - Fax:708-615-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-024174122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-024174OtherIL STATE DENTAL LIC #
IL20-0151353OtherTAX ID #