Provider Demographics
NPI:1932365905
Name:LAL, SHANTANU (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANTANU
Middle Name:
Last Name:LAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 63RD ST
Mailing Address - Street 2:2404
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 RIVERSIDE BLVD
Practice Address - Street 2:HAPPY TEETH NY LLC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10069-1001
Practice Address - Country:US
Practice Address - Phone:212-810-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05 0563281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry