Provider Demographics
NPI:1518296276
Name:AHDOOT, MELODY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:AHDOOT
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 1:320 E SHORE RD
Mailing Address - Street 2:4C
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1733
Mailing Address - Country:US
Mailing Address - Phone:516-578-6788
Mailing Address - Fax:
Practice Address - Street 1:320 E SHORE RD
Practice Address - Street 2:4C
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1733
Practice Address - Country:US
Practice Address - Phone:516-578-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053076-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist