Healthcare Provider Details

I. General information

NPI: 1982385100
Provider Name (Legal Business Name): SHAY MARKOVITCH DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S CLINTON AVE STE 510
ROCHESTER NY
14618-5721
US

IV. Provider business mailing address

1815 S CLINTON AVE STE 510
ROCHESTER NY
14618-5721
US

V. Phone/Fax

Practice location:
  • Phone: 585-632-4819
  • 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 Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WORTHMAN
Title or Position: REGIONAL MANAGER
Credential:
Phone: 845-842-9221