Provider Demographics
NPI:1295868826
Name:MUKAMAL, EDMOND O (DDS)
Entity type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:O
Last Name:MUKAMAL
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 1:150 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1241
Mailing Address - Country:US
Mailing Address - Phone:516-374-9100
Mailing Address - Fax:516-374-9105
Practice Address - Street 1:150 IRVING PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1241
Practice Address - Country:US
Practice Address - Phone:516-374-9100
Practice Address - Fax:516-374-9105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist