Healthcare Provider Details

I. General information

NPI: 1053761254
Provider Name (Legal Business Name): MOHAMED EL-OUNSI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 DEER PARK AVE STE 1
DEER PARK NY
11729-2729
US

IV. Provider business mailing address

1992 DEER PARK AVE STE 1
DEER PARK NY
11729-2729
US

V. Phone/Fax

Practice location:
  • Phone: 631-667-0004
  • Fax:
Mailing address:
  • Phone: 631-667-0004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number04614
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1858814
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number060246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: