Provider Demographics
NPI:1669684114
Name:RABAH, MOHAMMAD W (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:W
Last Name:RABAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1565
Mailing Address - Country:US
Mailing Address - Phone:212-567-5536
Mailing Address - Fax:212-202-6447
Practice Address - Street 1:3915 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1565
Practice Address - Country:US
Practice Address - Phone:212-567-5536
Practice Address - Fax:212-202-6447
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022680001223G0001X
NY055456-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice