=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295481562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDHILL DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2022
-----------------------------------------------------
Last Update Date | 02/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WESCOTT DR STE 202
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-788-5001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 WESCOTT DR STE 202
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-788-5001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | SHERVIN SHOJAI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 908-788-5001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------