Provider Demographics
NPI:1184732455
Name:ABUAHAMED, ABDULKADER (DDS)
Entity type:Individual
Prefix:
First Name:ABDULKADER
Middle Name:
Last Name:ABUAHAMED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37-14 73RD ST
Mailing Address - Street 2:# 201
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-446-0095
Mailing Address - Fax:718-235-1811
Practice Address - Street 1:37-14 73RD ST
Practice Address - Street 2:# 201
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:203-957-8700
Practice Address - Fax:203-957-8702
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01521815Medicaid