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General NPI Number Information
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NPI Number | 1083777106
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Entity Type | Organization
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Legal Business Name | SHAKUN SALOMONS & BRAY, DENTAL P.C.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 18 LEROY ST
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City | BINGHAMTON
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State | NY
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Zip | 13905-4603
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Country | US
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Telephone | 607-723-8377
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Fax | 607-722-1059
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Provider Business Mailing Address
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Address Line | 18 LEROY ST
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City | BINGHAMTON
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State | NY
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Zip | 13905-4603
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Country | US
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Telephone | 607-723-8377
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Fax | 607-722-1059
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM R SHAKUN
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Credential | D.M.D.
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Telephone | 607-723-8377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 027028
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 044401
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 048942
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 033411
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License Number State | NY
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