Organization
MATTESON ORTHODONTICS MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEYUR A SHAH DDS, MS (PRESIDENT)
(708) 481-6086
Entity
Organization
Contact information
Practice address
4440 LINCOLN HWY, SUITE 300, MATTESON, IL 60443-2349
(708) 481-6086
(708) 481-2525
Mailing address
4440 LINCOLN HWY, SUITE 300, MATTESON, IL 60443-2349
(708) 481-6086
(708) 481-2525
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021002232
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19025814
HFS DENTAL PROGRAM
IL
Enumeration date
06/01/2011
Last updated
06/01/2011
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