Provider Demographics
NPI:1871795922
Name:HOSSAIN, MOHAMMMAD (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMMAD
Middle Name:
Last Name:HOSSAIN
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 1:89-67 97TH STREET
Mailing Address - Street 2:HOUSE
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421
Mailing Address - Country:US
Mailing Address - Phone:718-439-2876
Mailing Address - Fax:718-439-2879
Practice Address - Street 1:89-67 97TH STREET
Practice Address - Street 2:HOUSE
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421
Practice Address - Country:US
Practice Address - Phone:718-439-2876
Practice Address - Fax:718-439-2879
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043291-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01259109Medicaid
NY1871795922OtherNPI