Healthcare Provider Details

I. General information

NPI: 1184732455
Provider Name (Legal Business Name): ABDULKADER ABUAHAMED DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37-14 73RD ST # 201
JACKSON HTS NY
11372
US

IV. Provider business mailing address

37-14 73RD ST # 201
JACKSON HTS NY
11372
US

V. Phone/Fax

Practice location:
  • Phone: 203-957-8700
  • Fax: 203-957-8702
Mailing address:
  • Phone: 718-446-0095
  • Fax: 718-235-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number045634
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: