Healthcare Provider Details

I. General information

NPI: 1720175532
Provider Name (Legal Business Name): SAMINA SHAKIR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 2ND STREET DENTAL HEALTH ASSOCIATES PA
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

320 SOUTH MAIN STREET DENTAL HEALTH ASSOCIATES PA CORPORATE OFFICE 2ND FLR
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-3030
  • Fax: 908-755-2755
Mailing address:
  • Phone: 908-387-6120
  • Fax: 908-387-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI022162
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: