Individual
KETAKI SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
615 S RANDALL ROAD, ELGIN, IL 60123
(847) 697-5100
(847) 697-5109
Mailing address
1990 RIDGEMORE DR, BARTLETT, IL 60103-1320
(847) 697-5100
(847) 697-5109
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025546
IL
Other
Enumeration date
01/22/2010
Last updated
01/22/2010
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