Provider Demographics
NPI:1174736888
Name:THOMAS, SHANTI (DMD)
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GREENE ST
Mailing Address - Street 2:UNIT 209
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4545
Mailing Address - Country:US
Mailing Address - Phone:201-433-6077
Mailing Address - Fax:
Practice Address - Street 1:133 MORNINGSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10027
Practice Address - Country:US
Practice Address - Phone:212-923-2525
Practice Address - Fax:646-981-9457
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist