4TH Avenue Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

036630 Issued in 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

Last updated

Feb 5, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Haresh I Shah, DDSNPI 1437172996

Title

President

Phone

(914) 664-5342

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Haresh I Shah, DDS

  • General Practice Dentistry
  • Mount Vernon, NY
  • NPI 1437172996
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233792000000",
    "number": "1356580914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11033 64TH AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113751428",
            "telephone_number": "917-886-4568",
            "fax_number": "718-275-3049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 S 4TH AVE",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105503106",
            "telephone_number": "914-664-5342",
            "fax_number": "718-275-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4TH AVENUE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2009-02-05",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "HARESH",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "914-664-5342",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "036630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Mount Vernon, NY
• Providers in Mount Vernon, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.