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General NPI Number Information
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NPI Number | 1174719991
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Entity Type | Individual
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Provider Name | MAHAMMED ABDUS SAMAD D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2007
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Last Update Date | 03/01/2020
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Provider Practice Location Address
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Address Line | 8810 175TH ST STE 1
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City | JAMAICA
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State | NY
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Zip | 11432-5570
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Country | US
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Telephone | 718-374-3222
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Fax | 718-374-3213
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Provider Business Mailing Address
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Address Line | 8810 175TH ST STE 1
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City | JAMAICA
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State | NY
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Zip | 11432-5570
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Country | US
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Telephone | 718-374-3222
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Fax | 718-374-3213
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 043080
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License Number State | NY
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