Provider Demographics
NPI:1275057614
Name:MOLAR DENTISTRY PLLC
Entity Type:Organization
Organization Name:MOLAR DENTISTRY PLLC
Other - Org Name:MOLAR TO MOLAR DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAIFALI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMETRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-771-1577
Mailing Address - Street 1:822 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3740
Mailing Address - Country:US
Mailing Address - Phone:516-717-2690
Mailing Address - Fax:516-717-2691
Practice Address - Street 1:822 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3740
Practice Address - Country:US
Practice Address - Phone:516-717-2690
Practice Address - Fax:516-717-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0544751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05364154Medicaid