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General NPI Number Information
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NPI Number | 1144492984
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Entity Type | Individual
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Provider Name | SHALOM MINTZ DDS, MS, PC
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Gender | Male
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 873 ROUTE 45 STE 201
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City | NEW CITY
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State | NY
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Zip | 10956-1116
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Country | US
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Telephone | 845-259-2500
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Fax | 845-406-4048
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Provider Business Mailing Address
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Address Line | 873 ROUTE 45 STE 201
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City | NEW CITY
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State | NY
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Zip | 10956-1116
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Country | US
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Telephone | 845-259-2500
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Fax | 845-406-4048
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 052148
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02342800
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License Number State | NJ
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