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NPI Code Detail

MEDICARE: DR. TEJAL VINOD SHASTRI D.D.S.

MEDICARE: DR. TEJAL VINOD SHASTRI D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist053740NY

General Provider Information

NPI Number : 1215118591
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TEJAL VINOD SHASTRI D.D.S.
Provider Business Mailing Address
First Line : 176 KINGSBERRY DR
Second Line : APT. A
City : ROCHESTER
State : NY
Zip : 14626-2220
Country : US
Telephone Number : 414-803-0020
Fax Number :
Provider Business Practice Location Address
First Line : 625 ELMWOOD AVE
Second Line : BOX 683
City : ROCHESTER
State : NY
Zip : 14620-2913
Country : US
Telephone Number : 585-275-5688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2007
Last Update Date : 08/19/2016

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