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General NPI Number Information
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NPI Number | 1972923803
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Entity Type | Organization
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Legal Business Name | DESIRE DENTAL CARE P.C.
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Dates
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Enumeration Date | 04/18/2014
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 100 NEWBRIDGE RD STE 8
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City | HICKSVILLE
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State | NY
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Zip | 11801-3948
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Country | US
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Telephone | 516-318-3787
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Fax |
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Provider Business Mailing Address
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Address Line | 100 NEWBRIDGE RD STE 8
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City | HICKSVILLE
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State | NY
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Zip | 11801-3948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIRAL L SHAH
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Credential | DDS
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Telephone | 516-318-3787
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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 | 056277-1
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License Number State | NY
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