Provider Demographics
NPI:1376799536
Name:MOURAD, FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:MOURAD
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 1:165 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-4911
Mailing Address - Country:US
Mailing Address - Phone:845-561-3290
Mailing Address - Fax:
Practice Address - Street 1:165 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-4911
Practice Address - Country:US
Practice Address - Phone:845-561-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist