Healthcare Provider Details

I. General information

NPI: 1336500883
Provider Name (Legal Business Name): DOSHI DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24202 61ST AVE
DOUGLASTON NY
11362-1968
US

IV. Provider business mailing address

560 S BROADWAY
HICKSVILLE NY
11801-5013
US

V. Phone/Fax

Practice location:
  • Phone: 516-937-2222
  • Fax: 516-977-1451
Mailing address:
  • Phone: 516-937-2222
  • Fax: 516-977-1451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number031373
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number031373
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number031373
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number031373
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number031373
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number031373
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number031373
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number031373
License Number StateNY

VIII. Authorized Official

Name: DR. NITIN DOSHI
Title or Position: MEMBER
Credential: DDS
Phone: 516-937-2222