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General NPI Number Information
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NPI Number | 1366985491
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Entity Type | Organization
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Legal Business Name | JESAL SHAH, DMD, P.C.
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 4609 5TH AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11220-1207
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Country | US
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Telephone | 718-854-3191
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Fax | 718-909-1635
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Provider Business Mailing Address
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Address Line | 4609 5TH AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11220-1207
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Country | US
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Telephone | 718-854-3191
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Fax | 718-909-1635
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESAL SHAH
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Credential | DMD
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Telephone | 516-395-2659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 052986
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License Number State | NY
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