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Organization

TOOTHTIMEDENTALSTUDIOPC

Active
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Organization

TOOTHTIMEDENTALSTUDIOPC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SEJAL U SHAH DDS (PRESIDENT)
(515) 519-8080
Entity
Organization

Contact information

Practice address
414 JERICHO TPKE, SUIT #2, NEW HYDE PARK, NY 11040-4510
(516) 519-8080
(516) 519-8082
Mailing address
PO BOX 81, ALBERTSON, ALBERTSON, NY 11507-0081
(516) 519-8080
(516) 519-8082

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1223P0221X
Pediatric Dentistry
1223P0300X
Periodontics
124Q00000X
Dental Hygienist
126800000X
Dental Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02145619
NY
Enumeration date
01/17/2013
Last updated
01/17/2013
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