Shah Dental Clinic,LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027170 Issued in IL

Legal business name

SHAH DENTAL CLINIC,LLC

Practice address

135 S Sycamore St
Centralia, IL 62801-3525

Phone

(618) 532-1411

Fax

(618) 532-1496

NPI assigned

Mar 31, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Kianor Shahmohammadi, D.M.D.NPI 1184747362

Title

Owner

Phone

(618) 532-1411

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kianor Shahmohammadi, DMD

  • General Practice Dentistry
  • Centralia, IL
  • NPI 1184747362
  NPD (past) Authorized official
• Nari Cho

  • Dentist
  • Centralia, IL
  • NPI 1467681999
  NPD (past)

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

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238457600000",
    "number": "1669614145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 S SYCAMORE ST",
            "address_2": "P.O. BOX 703",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013525",
            "telephone_number": "618-532-1411",
            "fax_number": "618-532-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 S SYCAMORE ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013525",
            "telephone_number": "618-532-1411",
            "fax_number": "618-532-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAH DENTAL CLINIC,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-31",
        "last_updated": "2009-03-31",
        "status": "A",
        "authorized_official_last_name": "SHAHMOHAMMADI",
        "authorized_official_first_name": "KIANOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-532-1411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karla Anne Schutzenhofer, APN
• Brook Sechrest
• Select Physical Therapy Holdings, Inc.
• Britni Sellers
• Serine Diagnostics Inc.
• Syed Ahmed Shah, M.D.
• Kianor Shahmohammadi, DMD
• Jonathan Anthony Sheckles, M.H.P
• Diana Lee Sherman, PTA
• Kiritkumar R Sheth, MD

• General Practice Dentistry in Centralia, IL
• Providers in Centralia, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2009; 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.