4TH Avenue Dental PC
Organization Active NPI General Practice Dentistry · Mount Vernon, NY
NPI 1356580914 · NPPES record last updated Feb 5, 2009
Key facts
- NPI
- 1356580914
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 036630 (NY)
- Legal business name
- 4TH AVENUE DENTAL PC
- Practice address
- 157 S 4TH Ave
Mount Vernon, NY 10550-3106 - Phone
- (914) 664-5342
- Fax
- (718) 275-3049
- NPI assigned
- Feb 5, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Haresh I Shah, DDS
- Title
- President
- Phone
- (914) 664-5342
Practitioners 1
-
Haresh I Shah, DDS
National Provider Directory
Locations
157 S 4th Ave
Mount Vernon, NY 10550
Phone (914) 664-5342
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 036630 | NY | Yes |
Addresses
Primary practice location
157 S 4TH Ave
Mount Vernon, NY 10550-3106
Mailing address
11033 64TH Ave
Forest Hills, NY 11375-1428
Phone (917) 886-4568
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00729819 | Medicaid | NY |
Other providers in Mount Vernon, NY
- 187 Cottage Avenue Corp
- 32 Proctor Pharmacy Inc.
- 4TH Ave Drug Store Inc
- A&Z Drug Store, Inc.
- Ab Surgical Supply Co., Inc.
- Jessica Abad
- Abdollah Yamani MD PC
- Abdullah Medical PC
All providers in Mount Vernon, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.