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General NPI Number Information
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NPI Number | 1720627243
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Entity Type | Organization
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Legal Business Name | SHIVAM DENTAL LLC
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Dates
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Enumeration Date | 01/01/2020
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 800 MAIN STREET SUIT 102
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City | HELLERTOWN
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State | PA
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Zip | 18055
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Country | US
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Telephone | 610-838-6597
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Fax |
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Provider Business Mailing Address
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Address Line | 6722 ARBORDEAU LN
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City | MACUNGIE
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State | PA
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Zip | 18062-8794
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Country | US
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Telephone | 732-429-6911
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | RAJESH KASWALA
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Credential | DMD
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Telephone | 732-429-6911
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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 |
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License Number State |
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