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General NPI Number Information
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NPI Number | 1982410221
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Entity Type | Organization
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Legal Business Name | DENTIST ON AVENUE T
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Dates
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Enumeration Date | 12/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 3310 NOSTRAND AVE STE L3
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City | BROOKLYN
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State | NY
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Zip | 11229-3739
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Country | US
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Telephone | 718-375-9257
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Fax |
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Provider Business Mailing Address
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Address Line | 3310 NOSTRAND AVE STE L3
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City | BROOKLYN
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State | NY
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Zip | 11229-3739
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOHANED AHMED
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Credential |
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Telephone | 718-375-9257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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