Provider Demographics
NPI:1235299421
Name:IYER, SHANKAR (DDS MDS)
Entity Type:Individual
Prefix:
First Name:SHANKAR
Middle Name:
Last Name:IYER
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MORRIS AVENUE
Mailing Address - Street 2:300
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208
Mailing Address - Country:US
Mailing Address - Phone:908-527-8880
Mailing Address - Fax:908-527-8587
Practice Address - Street 1:469 MORRIS AVENUE
Practice Address - Street 2:300 SMILE USA
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208
Practice Address - Country:US
Practice Address - Phone:908-527-8880
Practice Address - Fax:908-527-8587
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ192451223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7221606Medicaid