Provider Demographics
NPI:1871750760
Name:JUMAN, KALAMODEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KALAMODEEN
Middle Name:
Last Name:JUMAN
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 1:3702 ASTORIA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3666
Mailing Address - Country:US
Mailing Address - Phone:718-440-9858
Mailing Address - Fax:
Practice Address - Street 1:3702 ASTORIA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3666
Practice Address - Country:US
Practice Address - Phone:718-440-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15569122300000X
FLDN155691223G0001X
NY044317122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice