Provider Demographics
NPI:1942394911
Name:DEHIS, ISLAM MOHAMMAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ISLAM
Middle Name:MOHAMMAD
Last Name:DEHIS
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 1:205 BAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-3102
Mailing Address - Country:US
Mailing Address - Phone:631-922-4444
Mailing Address - Fax:
Practice Address - Street 1:205 BAY DR
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-3102
Practice Address - Country:US
Practice Address - Phone:631-922-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053317122300000X
MA1856553122300000X
CT010983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist