Provider Demographics
NPI:1083777106
Name:SHAKUN SALOMONS & BRAY, DENTAL P.C.
Entity Type:Organization
Organization Name:SHAKUN SALOMONS & BRAY, DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-723-8377
Mailing Address - Street 1:18 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4603
Mailing Address - Country:US
Mailing Address - Phone:607-723-8377
Mailing Address - Fax:607-722-1059
Practice Address - Street 1:18 LEROY ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4603
Practice Address - Country:US
Practice Address - Phone:607-723-8377
Practice Address - Fax:607-722-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0334111223G0001X
NY0270281223G0001X
NY0444011223G0001X
NY0489421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty