Provider Demographics
NPI:1750686051
Name:MADELINE SHAKIN DDS KEVIN SHEREN DDS PC
Entity Type:Organization
Organization Name:MADELINE SHAKIN DDS KEVIN SHEREN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-581-1188
Mailing Address - Street 1:369 E MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2800
Mailing Address - Country:US
Mailing Address - Phone:631-581-1188
Mailing Address - Fax:631-581-6909
Practice Address - Street 1:369 E MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2800
Practice Address - Country:US
Practice Address - Phone:631-581-1188
Practice Address - Fax:631-581-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6481860001Medicare NSC