Organization
CANARSIE MODERN DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOOROSH SHAMTOUB (OWNER)
(718) 257-0300
Entity
Organization
Contact information
Practice address
9413 FLATLANDS AVE STE 102W, BROOKLYN, NY 11236-3713
(718) 257-0300
Mailing address
9413 FLATLANDS AVE STE 102W, BROOKLYN, NY 11236-3713
(718) 257-0300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/17/2024
Last updated
08/20/2024
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