Provider Demographics
NPI:1134307747
Name:SAYED, IQBAL (DDS)
Entity Type:Individual
Prefix:MR
First Name:IQBAL
Middle Name:
Last Name:SAYED
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 1:450 WAVERLY AVE
Mailing Address - Street 2:SUITE #06
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-758-6689
Mailing Address - Fax:631-758-6693
Practice Address - Street 1:450 WAVERLY AVE
Practice Address - Street 2:SUITE #06
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-758-6689
Practice Address - Fax:631-758-6693
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00646355Medicaid