Healthcare Provider Details

I. General information

NPI: 1972372670
Provider Name (Legal Business Name): MONA A HALEEM DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE SPRUCE BLVD STE 104
ROCHESTER NY
14623-1605
US

IV. Provider business mailing address

200 WHITE SPRUCE BLVD STE 104
ROCHESTER NY
14623-1605
US

V. Phone/Fax

Practice location:
  • Phone: 585-358-0460
  • Fax: 585-358-0461
Mailing address:
  • Phone: 585-358-0460
  • Fax: 585-358-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MONA AMTULLAH HALEEM
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 585-358-0460