Provider Demographics
NPI:1174719991
Name:SAMAD, MAHAMMED ABDUS (DDS)
Entity type:Individual
Prefix:DR
First Name:MAHAMMED
Middle Name:ABDUS
Last Name:SAMAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 175TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5570
Mailing Address - Country:US
Mailing Address - Phone:718-374-3222
Mailing Address - Fax:718-374-3213
Practice Address - Street 1:8810 175TH ST STE 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5570
Practice Address - Country:US
Practice Address - Phone:718-374-3222
Practice Address - Fax:718-374-3213
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice