Healthcare Provider Details

I. General information

NPI: 1831351055
Provider Name (Legal Business Name): MONICA SHARMA TANNA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PLANDOME RD STE 102
MANHASSET NY
11030-1937
US

IV. Provider business mailing address

60 ALDERSHOT LN
MANHASSET NY
11030-3716
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-3535
  • Fax:
Mailing address:
  • Phone: 443-783-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number58174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number055400-1
License Number StateNY

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: