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General NPI Number Information
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NPI Number | 1326105594
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Entity Type | Individual
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Provider Name | DAVID M MOMTAHENI D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 630 5TH AVE 1868
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City | NEW YORK
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State | NY
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Zip | 10111-0100
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Country | US
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Telephone | 212-969-9133
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Fax | 212-969-9108
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Provider Business Mailing Address
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Address Line | 630 5TH AVE. 1868
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City | NEW YORK
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State | NY
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Zip | 10111-1862
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Country | US
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Telephone | 212-969-9133
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Fax | 212-969-9108
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 38085
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License Number State | NY
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