Provider Demographics
NPI:1558815738
Name:SHAH, ROHAN VIKRAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ROHAN
Middle Name:VIKRAM
Last Name:SHAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10735 CLOCKTOWER DR, UNIT 303
Mailing Address - Street 2:UNIT 303
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:832-766-0144
Mailing Address - Fax:832-766-0144
Practice Address - Street 1:1003 S WASHINGTON ST STE 225
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7445
Practice Address - Country:US
Practice Address - Phone:630-796-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190308021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice