Provider Demographics
NPI:1801192323
Name:FORT HAMILTON DENTAL
Entity Type:Organization
Organization Name:FORT HAMILTON DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDELAZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:OUZIDANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-238-4133
Mailing Address - Street 1:7523 FORT HAMILTON PKWY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2342
Mailing Address - Country:US
Mailing Address - Phone:718-238-4133
Mailing Address - Fax:718-238-9843
Practice Address - Street 1:7523 FORT HAMILTON PKWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2342
Practice Address - Country:US
Practice Address - Phone:718-238-4133
Practice Address - Fax:718-238-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty