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General NPI Number Information
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NPI Number | 1972931541
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Entity Type | Organization
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Legal Business Name | BROOKLYN ORTHODONTICS
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 9012 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-5908
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Country | US
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Telephone | 718-333-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 9012 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-5908
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Country | US
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Telephone | 718-333-5898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED AL-JANABI
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Credential | DDS
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Telephone | 718-333-5898
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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 | 056648
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 271533
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 053152
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License Number State | NY
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