Organization
4TH AVENUE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARESH I SHAH DDS (PRESIDENT)
(914) 664-5342
Entity
Organization
Contact information
Practice address
157 S 4TH AVE, MOUNT VERNON, NY 10550-3106
(914) 664-5342
(718) 275-3049
Mailing address
11033 64TH AVE, FOREST HILLS, NY 11375-1428
(917) 886-4568
(718) 275-3049
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
036630
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00729819
—
NY
Enumeration date
02/05/2009
Last updated
02/05/2009
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