Provider Demographics
NPI:1093140832
Name:MANISH V SHELADIA DMD
Entity Type:Organization
Organization Name:MANISH V SHELADIA DMD
Other - Org Name:MAJESTIC DENTISTRY OF GASTONIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-864-6721
Mailing Address - Street 1:825 MAJESTIC CT
Mailing Address - Street 2:SUITE - C
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5186
Mailing Address - Country:US
Mailing Address - Phone:704-864-6721
Mailing Address - Fax:704-864-1175
Practice Address - Street 1:825 MAJESTIC CT
Practice Address - Street 2:SUITE - C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5186
Practice Address - Country:US
Practice Address - Phone:704-864-6721
Practice Address - Fax:704-864-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08475261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental