# SPA DENTAL GROUP INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SPA DENTAL GROUP, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1346886884
- **Legal business name:** SPA DENTAL GROUP, INC.
- **Authorized official:** SHEBANI PAHWA DDS (CEO)
- **Authorized official phone:** (301) 910-3100

## Contact information

- **Practice address:** 111 E 57TH ST \# 204, NEW YORK, NY 10022-2009
- **Practice address phone:** (202) 431-6957
- **Mailing address:** 111 E 57TH ST STE 204, NEW YORK, NY 10022-2009
- **Mailing address phone:** (917) 858-7155
- **Mailing address fax:** (732) 631-8525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/19/2019
- **Last updated:** 12/15/2021