Provider Demographics
NPI:1891250007
Name:MORDEHAI AHDUT DDS PC
Entity Type:Organization
Organization Name:MORDEHAI AHDUT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORDEHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHDUT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-338-5700
Mailing Address - Street 1:4205 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3519
Mailing Address - Country:US
Mailing Address - Phone:718-338-5700
Mailing Address - Fax:
Practice Address - Street 1:4205 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3519
Practice Address - Country:US
Practice Address - Phone:718-338-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty