=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689858565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUTE DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2007
-----------------------------------------------------
Last Update Date | 12/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1749 GRAND CONCOURSE GROUND FL
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-466-2222
-----------------------------------------------------
Fax | 718-466-6555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16701 HILLSIDE AVE 2ND FL.
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-4289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-526-5999
-----------------------------------------------------
Fax | 718-466-6555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MOHAMMAD WAHEDUR RAHMAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 718-466-2222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 046388
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------