Healthcare Provider Details

I. General information

NPI: 1679266514
Provider Name (Legal Business Name): DHARA N SHIHORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 MAIN AVE
PASSAIC NJ
07055-4919
US

IV. Provider business mailing address

74 INSLEY AVE
RUTHERFORD NJ
07070-1825
US

V. Phone/Fax

Practice location:
  • Phone: 973-291-3640
  • Fax:
Mailing address:
  • Phone: 980-349-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03037600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: