Provider Demographics
NPI:1487800421
Name:R.M. DENTAL P.C.
Entity type:Organization
Organization Name:R.M. DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:RAWIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-254-8240
Mailing Address - Street 1:1005 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8207
Mailing Address - Country:US
Mailing Address - Phone:631-254-8240
Mailing Address - Fax:631-254-8214
Practice Address - Street 1:1005 COMMACK RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-8207
Practice Address - Country:US
Practice Address - Phone:631-254-8240
Practice Address - Fax:631-254-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540541Medicaid