Provider Demographics
NPI:1033955695
Name:ELBAHARY, SHLOMO (DMD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHLOMO
Middle Name:
Last Name:ELBAHARY
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E RANDOLPH ST APT 1402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-8043
Mailing Address - Country:US
Mailing Address - Phone:312-728-0400
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST RM 302A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-996-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL136.0002741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics