Brian Shah, DDS, MD, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019028191 Issued in IL

Legal business name

BRIAN SHAH, DDS, MD, PC

Practice address

1009 W Webster Ave
Chicago, IL 60614-3502

Phone

(872) 829-3280

Fax

(872) 829-3281

NPI assigned

Sep 24, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Brian Shah, M.D., D.D.S.

Title

President

Phone

(312) 659-6163

Specialties & licenses 1

Addresses

Other names 1

• Chicago Surgical Arts Doing business as

Locations

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

{
    "created_epoch": "1379980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1386070167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 W WEBSTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143502",
            "telephone_number": "872-829-3280",
            "fax_number": "872-829-3281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 W WEBSTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606143502",
            "telephone_number": "872-829-3280",
            "fax_number": "872-829-3281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN SHAH, DDS, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-24",
        "last_updated": "2013-09-24",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-659-6163",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019028191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicago Surgical Arts",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oral and Maxillofacial Surgery (Dentist) in Chicago, IL
• Providers in Chicago, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.