Provider Demographics
NPI:1659788008
Name:116 STREET DENTAL CARE PLLC
Entity Type:Organization
Organization Name:116 STREET DENTAL CARE PLLC
Other - Org Name:UPTOWN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEHEIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-573-3333
Mailing Address - Street 1:240 W 116TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2431
Mailing Address - Country:US
Mailing Address - Phone:347-331-6681
Mailing Address - Fax:
Practice Address - Street 1:240 W 116TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2431
Practice Address - Country:US
Practice Address - Phone:347-331-6681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03693818Medicaid