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Organization
SHAFEEQ H. BADER, D.D.S., S.C.
Active
Organization
SHAFEEQ H. BADER, D.D.S., S.C.
Active
Other names
Dental Impressions
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAFEEQ BADER DDS (PRESIDENT)
(630) 452-6950
Entity
Organization
Contact information
Practice address
5430 S KEDZIE AVE, CHICAGO, IL 60632-2620
(773) 925-0650
Mailing address
5430 S KEDZIE AVE, CHICAGO, IL 60632-2620
(773) 925-0650
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025521
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019025521
—
IL
Enumeration date
02/02/2017
Last updated
02/02/2017
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