Provider Demographics
NPI:1124001136
Name:GHADIALI, YASMIN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:J
Last Name:GHADIALI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2686 BELCHER ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3937
Mailing Address - Country:US
Mailing Address - Phone:718-467-3098
Mailing Address - Fax:
Practice Address - Street 1:314 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3022
Practice Address - Country:US
Practice Address - Phone:718-467-3098
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034128-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00350243Medicaid