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General NPI Number Information
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NPI Number | 1063144491
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Entity Type | Individual
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Provider Name | ANTONIOUS ATEF DIMYAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 9 MIDDLETOWN LINCROFT RD
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City | LINCROFT
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State | NJ
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Zip | 07738-1511
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Country | US
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Telephone | 732-842-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 14627 REEVES AVE
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City | FLUSHING
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State | NY
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Zip | 11367-1220
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Country | US
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Telephone | 917-569-7070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02902400
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License Number State | NJ
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