Syed Muhammad Shahabuddin, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019031376 Issued in IL

Practice address

311 N Bolingbrook Dr
Bolingbrook, IL 60440-1968

Phone

(630) 914-3505

Fax

(630) 914-3508

NPI assigned

Aug 23, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Syed Shahabuddin DDS, PLLC

  • Dental Clinic/Center
  • Bolingbrook, IL
  • NPI 1477260289
  NPD Authorized official
• Dental Professionals of Illinois, P.C.

  dba Family Dental Care of East Peoria

  • General Practice Dentistry
  • East Peoria, IL
  • NPI 1386985380
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1043737919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 W WASHINGTON ST",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616112036",
            "telephone_number": "309-694-4444",
            "fax_number": "309-694-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N BOLINGBROOK DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401968",
            "telephone_number": "630-914-3505",
            "fax_number": "630-914-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHABUDDIN",
        "first_name": "SYED",
        "middle_name": "MUHAMMAD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-23",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019031376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathaniel Edward Seville, MAED, ATC/L
• Shamil Shafi, DMD
• Shane Shafi, DMD
• Kinjal U. Shah, M.D.
• Surbhi Parth Shah, MD
• Rahil H Shaikh, MD
• Prashant Sharma
• Amanda Sharp, DPT, PT
• Michael Shay
• Theresa Sherdan, RPH

• Dentist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.