Provider Demographics
NPI:1396821682
Name:SHEL DENTAL, P.C.
Entity Type:Organization
Organization Name:SHEL DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-846-0200
Mailing Address - Street 1:181 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3626
Mailing Address - Country:US
Mailing Address - Phone:203-846-0200
Mailing Address - Fax:203-840-1958
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3626
Practice Address - Country:US
Practice Address - Phone:203-846-0200
Practice Address - Fax:203-840-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherALL INSURANCE COMPANIES