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General NPI Number Information
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NPI Number | 1376749549
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Entity Type | Organization
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Legal Business Name | PROSDENT
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2222 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3917
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Country | US
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Telephone | 718-761-6171
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Fax |
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Provider Business Mailing Address
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Address Line | 172 TOWNSEND DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-3352
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Country | US
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Telephone | 732-863-1682
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. GHAZWAN SAYED
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Credential | DMD, MS
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Telephone | 718-761-6171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 045614-1
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License Number State | NY
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