Healthcare Provider Details

I. General information

NPI: 1548454861
Provider Name (Legal Business Name): MIDDLETOWN DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BERT CRAWFORD RD SUITE 101
MIDDLETOWN NY
10940-2138
US

IV. Provider business mailing address

9 BERT CRAWFORD RD SUITE 101
MIDDLETOWN NY
10940-2138
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-2192
  • Fax: 845-342-9211
Mailing address:
  • Phone: 845-343-2192
  • Fax: 845-342-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number47090
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number47090
License Number StateNY

VIII. Authorized Official

Name: DR. CRAIG S SHAPIRO
Title or Position: PRESIDENT
Credential: DMD
Phone: 845-343-2192