Provider Demographics
NPI:1073791323
Name:FULTON PARK PLAZA DENTAL CARE P C
Entity Type:Organization
Organization Name:FULTON PARK PLAZA DENTAL CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-778-8512
Mailing Address - Street 1:8773 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3343
Mailing Address - Country:US
Mailing Address - Phone:718-291-1771
Mailing Address - Fax:718-291-1772
Practice Address - Street 1:8773 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3343
Practice Address - Country:US
Practice Address - Phone:718-778-8512
Practice Address - Fax:718-221-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0419821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01109677Medicaid