Individual
DHARA SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
520 N 4TH ST, SPRINGFIELD, IL 62702-5238
(217) 545-8000
(217) 757-8161
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
(217) 545-2101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.034239
IL
1223G0001X
General Practice Dentistry
Primary
019.034239
IL
1223G0001X
General Practice Dentistry
2901600908
MI
Other
Enumeration date
06/19/2021
Last updated
08/23/2023
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