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General NPI Number Information
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NPI Number | 1154592988
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Entity Type | Organization
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Legal Business Name | SARATOGA DENTAL PLLC
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 409 GEYSER RD SUITE B
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City | BALLSTON SPA
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State | NY
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Zip | 12020-3022
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Country | US
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Telephone | 518-583-3553
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Fax | 518-583-4676
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Provider Business Mailing Address
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Address Line | 409 GEYSER RD SUITE B
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City | BALLSTON SPA
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State | NY
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Zip | 12020-3022
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Country | US
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Telephone | 518-583-3553
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Fax | 518-583-4676
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHAZIA MEHDI
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Credential | DDS
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Telephone | 917-379-3677
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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 | 051533
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License Number State | NY
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