Provider Demographics
NPI:1184742777
Name:HAUPAGE, SHANTHI KUMARI (DDS)
Entity type:Individual
Prefix:DR
First Name:SHANTHI
Middle Name:KUMARI
Last Name:HAUPAGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KUMARI
Other - Middle Name:
Other - Last Name:SHANTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:297 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3589
Mailing Address - Country:US
Mailing Address - Phone:516-756-0111
Mailing Address - Fax:516-756-0330
Practice Address - Street 1:297 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3589
Practice Address - Country:US
Practice Address - Phone:516-756-0111
Practice Address - Fax:516-756-0330
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0397271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00935786Medicaid