Organization
KOOROSH SHAMTOUB DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KOOROSH SHAMTOUB DDS (CEO)
(718) 257-0300
Entity
Organization
Contact information
Practice address
9413 FLATLANDS AVE STE 102W, BROOKLYN, NY 11236-3713
(718) 257-0300
(718) 257-0670
Mailing address
9413 FLATLANDS AVE STE 102W, BROOKLYN, NY 11236-3713
(718) 257-0300
(718) 257-0670
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
051063
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02496220
—
NY
Enumeration date
09/07/2011
Last updated
09/07/2011
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