Healthcare Provider Details

I. General information

NPI: 1639098502
Provider Name (Legal Business Name): AHMAD AL-AKHRAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

2321 BELMONT AVE APT 2D
BRONX NY
10458-8391
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6628
  • Fax:
Mailing address:
  • Phone: 514-889-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: