Provider Demographics
NPI:1134564156
Name:BROOKLYN OAK DENTAL CARE
Entity type:Organization
Organization Name:BROOKLYN OAK DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIAMA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-996-8132
Mailing Address - Street 1:319 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2905
Mailing Address - Country:US
Mailing Address - Phone:718-369-2300
Mailing Address - Fax:718-369-2331
Practice Address - Street 1:319 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2905
Practice Address - Country:US
Practice Address - Phone:718-369-2300
Practice Address - Fax:718-369-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty