MEDICARE: DR. MOHAMMED SHAHABUDDIN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	042617	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245229210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED SHAHABUDDIN D.D.S

Provider Business Mailing Address
First Line	:	3004 36TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-2315
Country	:	US
Telephone Number	:	718-361-8677
Fax Number	:	718-361-0278

Provider Business Practice Location Address
First Line	:	3004 36TH AVE
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-2315
Country	:	US
Telephone Number	:	718-361-8677
Fax Number	:	718-361-0278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	04/26/2012

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