=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235300898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTALSMILEP.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2008
-----------------------------------------------------
Last Update Date | 03/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3003 30TH AVE STE 2
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11102-2168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-777-2577
-----------------------------------------------------
Fax | 718-777-0742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3003 30TH AVE STE 2
-----------------------------------------------------
City | ASTORIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11102-2168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-777-2577
-----------------------------------------------------
Fax | 718-777-0742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | D.D.S.
-----------------------------------------------------
Name | DR. WALEED MUGALLY SAIDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-777-2577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 050236
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------