Provider Demographics
NPI:1619327053
Name:SHAHMEHDI DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SHAHMEHDI DENTAL ASSOCIATES
Other - Org Name:PICTURE PERFECT SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SEYED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHMEHDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-256-2222
Mailing Address - Street 1:81 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1107
Mailing Address - Country:US
Mailing Address - Phone:973-256-2222
Mailing Address - Fax:973-256-3862
Practice Address - Street 1:81 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1107
Practice Address - Country:US
Practice Address - Phone:973-256-2222
Practice Address - Fax:973-256-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 0231860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty