Individual provider Active NPI

Rita Ramesh Shah, DDS

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1891867388
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-026413 Issued in IL
Practice address
3901 N Broadway, Chicago, Il 60613
Modern Smiles
Chicago, IL 60613
Phone
(312) 500-7080
Fax
(312) 610-5431
NPI assigned
Nov 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019-026413 IL Primary

Addresses

Primary practice location

3901 N Broadway, Chicago, Il 60613
Modern Smiles
Chicago, IL 60613

Mailing address

3901 N Broadway, Chicago, Il 60613
Modern Smiles
Chicago, IL 60613
Phone (312) 500-7080

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160526000943 IL Order and Referring Only - DentistPractitioner - Dentist 1153611595

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-026413ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1891867388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 N BROADWAY, CHICAGO, IL 60613",
            "address_2": "MODERN SMILES",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "312-500-7080",
            "fax_number": "312-610-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 N BROADWAY, CHICAGO, IL 60613",
            "address_2": "MODERN SMILES",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60613",
            "telephone_number": "312-500-7080",
            "fax_number": "312-610-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "RITA",
        "middle_name": "RAMESH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-026413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.