MEDICARE: GREENE AVE DENTAL PLLC

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1558909465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE AVE DENTAL PLLC

Provider Business Mailing Address
First Line	:	335 GREENE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238
Country	:	US
Telephone Number	:	718-623-0893
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 MURRAY ST FL 5
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-2244
Country	:	US
Telephone Number	:	212-346-0893
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	DR. SARA SHAHI
Credential	:	DDS
Telephone Number	:	917-282-9118

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	04/30/2024

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