Healthcare Provider Details

I. General information

NPI: 1285228361
Provider Name (Legal Business Name): CASSANDRA SHAHINIAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 MAIN ST
HACKENSACK NJ
07601-5136
US

IV. Provider business mailing address

277 CREST PL
FRANKLIN LAKES NJ
07417-2705
US

V. Phone/Fax

Practice location:
  • Phone: 201-464-4783
  • Fax:
Mailing address:
  • Phone: 781-267-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02823500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: