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General NPI Number Information
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NPI Number | 1740400712
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Entity Type | Organization
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Legal Business Name | MEENA JAISWAL, DDS
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 584 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5022
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Country | US
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Telephone | 516-797-7521
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Fax |
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Provider Business Mailing Address
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Address Line | 584 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5022
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Country | US
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Telephone | 516-797-7521
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | MEENA JAISWAL
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Credential | DDS
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Telephone | 516-797-7521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0415541
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License Number State | NY
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