MEDICARE: DR. FLORA MOUNESSA DDS

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	1223G0001X	General Practice Dentistry	049216	NY

General Provider Information

NPI Number	:	1326007667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLORA MOUNESSA DDS

Provider Business Mailing Address
First Line	:	18241 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2329
Country	:	US
Telephone Number	:	718-657-0000
Fax Number	:	718-657-0000

Provider Business Practice Location Address
First Line	:	18241 JAMAICA AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-2329
Country	:	US
Telephone Number	:	718-657-0000
Fax Number	:	718-657-0000

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/17/2011

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