Provider Demographics
NPI:1659472561
Name:SHAUN G MASSIAH DMD PC
Entity Type:Organization
Organization Name:SHAUN G MASSIAH DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:GRENVILLE
Authorized Official - Last Name:MASSIAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-222-5225
Mailing Address - Street 1:50 W 97TH ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6004
Mailing Address - Country:US
Mailing Address - Phone:212-222-5225
Mailing Address - Fax:212-222-4405
Practice Address - Street 1:50 W 97TH STREET SUITE 16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6004
Practice Address - Country:US
Practice Address - Phone:212-222-5225
Practice Address - Fax:212-222-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0474131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty