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General NPI Number Information
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NPI Number | 1316327760
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Entity Type | Organization
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Legal Business Name | JOHN SHI DDS PC
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 139 CENTRE ST #306
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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Country | US
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Telephone | 212-925-7066
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Fax | 201-255-0148
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Provider Business Mailing Address
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Address Line | 139 CENTRE ST #306
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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Country | US
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Telephone | 212-925-7066
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Fax | 201-255-0148
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN L SHI
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Credential | DDS
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Telephone | 917-640-8262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 048485
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License Number State | NY
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