Provider Demographics
NPI:1437132040
Name:BILLAH, MOHAMMAD MOTASIM (BDS)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:MOTASIM
Last Name:BILLAH
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7308
Mailing Address - Country:US
Mailing Address - Phone:718-384-0010
Mailing Address - Fax:718-599-4132
Practice Address - Street 1:302 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7308
Practice Address - Country:US
Practice Address - Phone:718-384-0010
Practice Address - Fax:718-599-4632
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2013-11-26
Deactivation Date:2008-07-17
Deactivation Code:
Reactivation Date:2013-06-25
Provider Licenses
StateLicense IDTaxonomies
NY0341291223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00374841Medicaid