Healthcare Provider Details

I. General information

NPI: 1801949078
Provider Name (Legal Business Name): AHMED M NOUR-EL-DEEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 DURHAM RD
EAST MEADOW NY
11554-4606
US

IV. Provider business mailing address

845 DURHAM RD
EAST MEADOW NY
11554-4606
US

V. Phone/Fax

Practice location:
  • Phone: 516-486-1430
  • Fax: 516-972-8629
Mailing address:
  • Phone: 516-486-1430
  • Fax: 516-972-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number042607
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: