Organization
FIFTH AVENUE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIRENDRA SHAH DDS (DENTIST)
(718) 854-3191
Entity
Organization
Contact information
Practice address
4607 5TH AVE # 1, BROOKLYN, NY 11220-1207
(718) 854-3191
(718) 272-4688
Mailing address
4607 5TH AVE # 1, BROOKLYN, NY 11220-1207
(718) 854-3191
(718) 272-4688
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
033327
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00398554
—
NY
Enumeration date
08/12/2006
Last updated
08/22/2020
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