Provider Demographics
NPI:1073897609
Name:BENJAMIN SHIRLEY , DDS, PC
Entity Type:Organization
Organization Name:BENJAMIN SHIRLEY , DDS, PC
Other - Org Name:UPPER WESTSIDE DEANTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:BANNEKER
Authorized Official - Last Name:SHIRLEY
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-667-6015
Mailing Address - Street 1:992 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2501
Mailing Address - Country:US
Mailing Address - Phone:917-667-6015
Mailing Address - Fax:
Practice Address - Street 1:992 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2501
Practice Address - Country:US
Practice Address - Phone:917-667-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05433811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty