Provider Demographics
NPI:1154592988
Name:SARATOGA DENTAL PLLC
Entity type:Organization
Organization Name:SARATOGA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-379-3677
Mailing Address - Street 1:409 GEYSER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3022
Mailing Address - Country:US
Mailing Address - Phone:518-583-3553
Mailing Address - Fax:518-583-4676
Practice Address - Street 1:409 GEYSER RD
Practice Address - Street 2:SUITE B
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-3022
Practice Address - Country:US
Practice Address - Phone:518-583-3553
Practice Address - Fax:518-583-4676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02602922Medicaid