Healthcare Provider Details

I. General information

NPI: 1396061594
Provider Name (Legal Business Name): IQBAL DENTAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16033 HIGHLAND AVE
JAMAICA NY
11432-3435
US

IV. Provider business mailing address

16033 HIGHLAND AVE
JAMAICA NY
11432-3435
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-0616
  • Fax: 718-291-0619
Mailing address:
  • Phone: 718-291-0616
  • Fax: 718-291-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number051351
License Number StateNY

VIII. Authorized Official

Name: DR. MAMOON IQBAL
Title or Position: V.P.
Credential: D.D.S.
Phone: 917-420-0311