Provider Demographics
NPI:1588174007
Name:SHANKARA, VIBHA BABBAR (DMD)
Entity type:Individual
Prefix:
First Name:VIBHA
Middle Name:BABBAR
Last Name:SHANKARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VIBHA
Other - Middle Name:
Other - Last Name:BABBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1550 N LOUISE LN
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-2427
Mailing Address - Country:US
Mailing Address - Phone:989-977-1771
Mailing Address - Fax:
Practice Address - Street 1:1535 S LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060
Practice Address - Country:US
Practice Address - Phone:847-566-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0314241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice