Provider Demographics
NPI:1134464936
Name:SHAHINE DENTAL, P.C.
Entity Type:Organization
Organization Name:SHAHINE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-622-6603
Mailing Address - Street 1:8075 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1691
Mailing Address - Country:US
Mailing Address - Phone:315-622-6603
Mailing Address - Fax:315-622-6606
Practice Address - Street 1:8075 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1691
Practice Address - Country:US
Practice Address - Phone:315-622-6603
Practice Address - Fax:315-622-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051526122300000X
NY056220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992070767OtherINDIVIDUAL NPI
1720076979OtherINDIVIDUAL NPI
NY02608079Medicaid