Provider Demographics
NPI:1588651871
Name:MAXIMOUS, NABIL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:NABIL
Middle Name:A
Last Name:MAXIMOUS
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 1:7 ATLAS WAY
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5234
Mailing Address - Country:US
Mailing Address - Phone:631-266-1410
Mailing Address - Fax:
Practice Address - Street 1:7 ATLAS WAY
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-5234
Practice Address - Country:US
Practice Address - Phone:631-266-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-01
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0349601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice