Provider Demographics
NPI:1134751837
Name:SHAAN DENTAL LLC
Entity type:Organization
Organization Name:SHAAN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANKOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:708-745-2758
Mailing Address - Street 1:15551 DEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7719
Mailing Address - Country:US
Mailing Address - Phone:708-745-2758
Mailing Address - Fax:
Practice Address - Street 1:5917 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4515
Practice Address - Country:US
Practice Address - Phone:708-439-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental