Healthcare Provider Details

I. General information

NPI: 1194713032
Provider Name (Legal Business Name): MASOOD H SYED D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 SUFFOLK AVE SUITE 108
BRENTWOOD NY
11717-4391
US

IV. Provider business mailing address

652 SUFFOLK AVE SUITE 108
BRENTWOOD NY
11717-4391
US

V. Phone/Fax

Practice location:
  • Phone: 361-273-5888
  • Fax: 631-273-4566
Mailing address:
  • Phone: 361-273-5888
  • Fax: 631-273-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: