Healthcare Provider Details

I. General information

NPI: 1164102414
Provider Name (Legal Business Name): AIDA AMIR POURSAEID DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date: 02/28/2024
Reactivation Date: 03/27/2024

III. Provider practice location address

345 E. 24TH STREET
NEW YORK NY
10010
US

IV. Provider business mailing address

345 E. 24TH STREET
NEW YORK NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9800
  • Fax:
Mailing address:
  • Phone: 212-998-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: