Provider Demographics
NPI:1508067943
Name:DILMANIAN, MINOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MINOO
Middle Name:
Last Name:DILMANIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2919
Mailing Address - Country:US
Mailing Address - Phone:845-562-2828
Mailing Address - Fax:845-245-3010
Practice Address - Street 1:19 LAUREL DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2919
Practice Address - Country:US
Practice Address - Phone:516-829-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00980534Medicaid