Provider Demographics
NPI:1326007667
Name:MOUNESSA, FLORA (DDS)
Entity Type:Individual
Prefix:DR
First Name:FLORA
Middle Name:
Last Name:MOUNESSA
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 1:18241 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2329
Mailing Address - Country:US
Mailing Address - Phone:718-657-0000
Mailing Address - Fax:718-657-0000
Practice Address - Street 1:18241 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2329
Practice Address - Country:US
Practice Address - Phone:718-657-0000
Practice Address - Fax:718-657-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0492161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199782Medicare ID - Type Unspecified