Provider Demographics
NPI:1386858660
Name:MANNAN, NABILA YASMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NABILA
Middle Name:YASMIN
Last Name:MANNAN
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 1:2509 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3209
Mailing Address - Country:US
Mailing Address - Phone:718-433-0515
Mailing Address - Fax:
Practice Address - Street 1:2533 36TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3209
Practice Address - Country:US
Practice Address - Phone:718-433-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047199-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01821127Medicaid