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Organization
MATTESON ORTHODONTICS MDPC
Active
Organization
MATTESON ORTHODONTICS MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEYUR A SHAH D.D.S. (CEO)
(708) 481-6086
Entity
Organization
Contact information
Practice address
4440 LINCOLN HWY STE 300, MATTESON, IL 60443-3804
(708) 481-6086
(708) 481-2525
Mailing address
4440 LINCOLN HWY STE 300, MATTESON, IL 60443-3804
(708) 481-6086
(708) 481-2525
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
021002232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021002232
ORTHO LICENSE #
IL
Enumeration date
03/09/2010
Last updated
03/09/2010
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