Healthcare Provider Details

I. General information

NPI: 1003955329
Provider Name (Legal Business Name): HODA YOUSEF DMD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST STE 7700
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

23 SAINT CHARLES ST
NEWARK NJ
07105-3921
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-2444
  • Fax:
Mailing address:
  • Phone: 973-344-1184
  • Fax: 973-972-0370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5020
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: