| 4th Avenue Dental Pc | |
|
157 S 4th Ave Mount Vernon NY 10550-3106 | |
| (914) 664-5342 | |
| (718) 275-3049 |
| Full Name | 4th Avenue Dental Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 157 S 4th Ave, Mount Vernon, New York |
| Authorized Official Name and Position | Haresh I Shah (PRESIDENT) |
| Authorized Official Contact | 9146645342 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 4th Avenue Dental Pc 11033 64th Ave Forest Hills NY 11375-1428 Ph: (917) 886-4568 | 4th Avenue Dental Pc 157 S 4th Ave Mount Vernon NY 10550-3106 Ph: (914) 664-5342 |
| NPI Number | 1356580914 |
|---|---|
| Provider Enumeration Date | 02/05/2009 |
| Last Update Date | 02/05/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356580914 | NPI | - | NPPES |
| 00729819 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 036630 (New York) | Primary |
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