| Jesal Shah, Dmd, P.c. | |
|
4609 5th Ave 2nd Floor Brooklyn NY 11220-1207 | |
| (718) 854-3191 | |
| (718) 909-1635 |
| Full Name | Jesal Shah, Dmd, P.c. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4609 5th Ave, Brooklyn, New York |
| Authorized Official Name and Position | Jesal Shah (PRESIDENT) |
| Authorized Official Contact | 5163952659 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jesal Shah, Dmd, P.c. 4609 5th Ave 2nd Floor Brooklyn NY 11220-1207 Ph: (718) 854-3191 | Jesal Shah, Dmd, P.c. 4609 5th Ave 2nd Floor Brooklyn NY 11220-1207 Ph: (718) 854-3191 |
| NPI Number | 1366985491 |
|---|---|
| Provider Enumeration Date | 11/21/2016 |
| Last Update Date | 11/21/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366985491 | NPI | - | NPPES |
| 03476693 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 052986 (New York) | Primary |
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