Fifth Avenue Dental PC

Primary specialty

DentistTaxonomy code 122300000X

License

033327 Issued in NY

Legal business name

FIFTH AVENUE DENTAL PC

Practice address

4607 5TH Ave # 1
Brooklyn, NY 11220-1207

Phone

(718) 854-3191

Fax

(718) 272-4688

NPI assigned

Aug 12, 2006

Last updated

Aug 22, 2020By 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. Virendra Shah, DDS

Title

Dentist

Phone

(718) 854-3191

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710999438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4607 5TH AVE # 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112201207",
            "telephone_number": "718-854-3191",
            "fax_number": "718-272-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4607 5TH AVE # 1",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112201207",
            "telephone_number": "718-854-3191",
            "fax_number": "718-272-4688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIFTH AVENUE DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "VIRENDRA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "718-854-3191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "033327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00398554",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Brooklyn, NY
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.