Provider Demographics
NPI:1952618761
Name:SARWAT SHENOUDA DENTIST PC
Entity Type:Organization
Organization Name:SARWAT SHENOUDA DENTIST PC
Other - Org Name:SARWAT SHENOUDA DENTIST PC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARWAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-735-0141
Mailing Address - Street 1:32 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2425
Mailing Address - Country:US
Mailing Address - Phone:845-735-0141
Mailing Address - Fax:845-735-1886
Practice Address - Street 1:32 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2425
Practice Address - Country:US
Practice Address - Phone:845-735-0141
Practice Address - Fax:845-735-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty