Provider Demographics
NPI:1487054938
Name:SHORE SMILES DENTAL, PC
Entity type:Organization
Organization Name:SHORE SMILES DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIGAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-797-0300
Mailing Address - Street 1:875 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2344
Mailing Address - Country:US
Mailing Address - Phone:516-797-0300
Mailing Address - Fax:
Practice Address - Street 1:875 N BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2344
Practice Address - Country:US
Practice Address - Phone:516-797-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055149261QD0000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty