Provider Demographics
NPI:1891894515
Name:SHASHIKANT N TOLIA,PC
Entity Type:Organization
Organization Name:SHASHIKANT N TOLIA,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHASHIKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:718-821-1516
Mailing Address - Street 1:5807 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1636
Mailing Address - Country:US
Mailing Address - Phone:718-821-1516
Mailing Address - Fax:
Practice Address - Street 1:266 SUYDAM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3262
Practice Address - Country:US
Practice Address - Phone:718-821-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0327411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty