=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841530706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAR DENTAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2013
-----------------------------------------------------
Last Update Date | 02/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 WASHINGTON ST SUITE LB2
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-483-7678
-----------------------------------------------------
Fax | 516-483-2857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 WASHINGTON ST SUITE LB2
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-3147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-483-7678
-----------------------------------------------------
Fax | 516-483-2857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SHEFALI MARCHAWALA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 516-483-7678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 047506-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------