Organization
JESAL SHAH, DMD, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESAL SHAH DMD (PRESIDENT)
(516) 395-2659
Entity
Organization
Contact information
Practice address
4609 5TH AVE, 2ND FLOOR, BROOKLYN, NY 11220-1207
(718) 854-3191
(718) 909-1635
Mailing address
4609 5TH AVE, 2ND FLOOR, BROOKLYN, NY 11220-1207
(718) 854-3191
(718) 909-1635
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
052986
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03476693
—
NY
Enumeration date
11/21/2016
Last updated
11/21/2016
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