Provider Demographics
NPI:1558909465
Name:GREENE AVE DENTAL PLLC
Entity Type:Organization
Organization Name:GREENE AVE DENTAL PLLC
Other - Org Name:TRIBECA DENTAL ASSOCIATE ON GREENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-282-9118
Mailing Address - Street 1:335 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238
Mailing Address - Country:US
Mailing Address - Phone:718-623-0893
Mailing Address - Fax:
Practice Address - Street 1:21 MURRAY ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-2244
Practice Address - Country:US
Practice Address - Phone:212-346-0893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty