Provider Demographics
NPI:1881150449
Name:EMERALD DENTAL SPA
Entity type:Organization
Organization Name:EMERALD DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-687-6061
Mailing Address - Street 1:397 CHESTNUT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9419
Mailing Address - Country:US
Mailing Address - Phone:908-687-6061
Mailing Address - Fax:
Practice Address - Street 1:397 CHESTNUT ST STE 1
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9419
Practice Address - Country:US
Practice Address - Phone:201-213-2331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty