Healthcare Provider Details

I. General information

NPI: 1902743651
Provider Name (Legal Business Name): SHAY MARKOVITCH DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W BAY PLZ
PLATTSBURGH NY
12901-1787
US

IV. Provider business mailing address

304 W BAY PLZ
PLATTSBURGH NY
12901-1787
US

V. Phone/Fax

Practice location:
  • Phone: 518-825-0025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: NATHANAEL SALLOUM
Title or Position: OPERATOR
Credential: DMD
Phone: 518-825-0025