Provider Demographics
NPI:1740400712
Name:MEENA JAISWAL, DDS
Entity Type:Organization
Organization Name:MEENA JAISWAL, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAISWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-797-7521
Mailing Address - Street 1:584 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5022
Mailing Address - Country:US
Mailing Address - Phone:516-797-7521
Mailing Address - Fax:
Practice Address - Street 1:584 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5022
Practice Address - Country:US
Practice Address - Phone:516-797-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04155411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty