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General NPI Number Information
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NPI Number | 1225692528
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Entity Type | Organization
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Legal Business Name | KRUPALI SHAH DDS PLLC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 549 STEWART AVE
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City | BETHPAGE
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State | NY
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Zip | 11714-2706
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Country | US
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Telephone | 516-288-8393
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Fax |
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Provider Business Mailing Address
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Address Line | 5 WILLETS DR
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City | SYOSSET
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State | NY
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Zip | 11791-3913
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Country | US
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Telephone | 773-407-1004
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRUPALI SHAH
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Credential | DDS
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Telephone | 773-407-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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