Provider Demographics
NPI:1164755989
Name:HABIB, AMR A (DDS)
Entity Type:Individual
Prefix:
First Name:AMR
Middle Name:A
Last Name:HABIB
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 1:42 SWEETIE LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-2829
Mailing Address - Country:US
Mailing Address - Phone:585-201-0170
Mailing Address - Fax:
Practice Address - Street 1:4 EXECUTIVE DRIVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-3717
Practice Address - Country:US
Practice Address - Phone:518-459-3485
Practice Address - Fax:518-459-3487
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30345390200000X
NY0602731223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program