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Organization
VANGUARD DENTAL, PLLC
Active
Organization
VANGUARD DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAKIBA JACKIE SHAYANI (DIRECTOR)
(516) 739-3000
Entity
Organization
Contact information
Practice address
200 OLD COUNTRY RD, SUITE 520, MINEOLA, NY 11501-4235
(516) 739-3000
Mailing address
200 OLD COUNTRY RD, SUITE 520, MINEOLA, NY 11501-4235
(516) 739-3000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/17/2012
Last updated
08/17/2012
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