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General NPI Number Information
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NPI Number | 1568799237
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Entity Type | Individual
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Provider Name | LEILA SHAKERI DMD
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Gender | Female
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 932 S MAIN ST
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-3646
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Country | US
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Telephone | 609-383-0880
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Fax | 609-383-0658
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Provider Business Mailing Address
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Address Line | 860 S WHITE HORSE PIKE
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City | HAMMONTON
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State | NJ
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Zip | 08037-2018
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Country | US
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Telephone | 609-561-9150
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Fax | 609-561-9383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 22D102424700
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License Number State | NJ
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