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General NPI Number Information
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NPI Number | 1871647677
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Entity Type | Individual
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Provider Name | IRINA SHAMALOVA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2071 2ND AVE
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City | NEW YORK
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State | NY
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Zip | 10029-4101
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Country | US
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Telephone | 212-410-6969
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Fax | 212-410-6989
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Provider Business Mailing Address
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Address Line | 9941 64TH AVE APT. A12
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City | REGO PARK
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State | NY
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Zip | 11374-2653
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Country | US
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Telephone | 917-749-6330
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Fax | 212-410-6989
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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 | 052022-1
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License Number State | NY
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