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General NPI Number Information
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NPI Number | 1558909465
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Entity Type | Organization
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Legal Business Name | GREENE AVE DENTAL PLLC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 21 MURRAY ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10007-2244
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Country | US
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Telephone | 212-346-0893
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Fax |
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Provider Business Mailing Address
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Address Line | 335 GREENE AVE
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City | BROOKLYN
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State | NY
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Zip | 11238
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Country | US
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Telephone | 718-623-0893
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SARA SHAHI
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Credential | DDS
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Telephone | 917-282-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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