Provider Demographics
NPI:1962611467
Name:SHABTAI, ANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:SHABTAI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E JERICHO TPKE
Mailing Address - Street 2:CARLE PLACE DENTAL PC
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1027
Mailing Address - Country:US
Mailing Address - Phone:516-747-8150
Mailing Address - Fax:516-747-8152
Practice Address - Street 1:407 E JERICHO TPKE
Practice Address - Street 2:CARLE PLACE DENTAL PC
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1027
Practice Address - Country:US
Practice Address - Phone:516-747-8150
Practice Address - Fax:516-747-8152
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0474051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01812591Medicaid