Healthcare Provider Details

I. General information

NPI: 1265729800
Provider Name (Legal Business Name): SHERINE NABIL BOTROS D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111-20 MERRICK BLVD
ST, ALBANS NY
11412
US

IV. Provider business mailing address

111-20 MERRICK BLVD
ST, ALBANS NY
11412
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-9662
  • Fax:
Mailing address:
  • Phone: 718-739-9662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number056093-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: