Provider Demographics
NPI:1134417892
Name:SHAHAB SOLEYMANI DDS PC
Entity type:Organization
Organization Name:SHAHAB SOLEYMANI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEYMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-932-6212
Mailing Address - Street 1:4105 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2908
Mailing Address - Country:US
Mailing Address - Phone:718-932-6212
Mailing Address - Fax:718-932-2113
Practice Address - Street 1:4105 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2908
Practice Address - Country:US
Practice Address - Phone:718-932-6212
Practice Address - Fax:718-932-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty