Provider Demographics
NPI:1720069651
Name:BHUYAN, MOHAMMAD WADUDUZZAMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:WADUDUZZAMAN
Last Name:BHUYAN
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 1:8950 164TH ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5142
Mailing Address - Country:US
Mailing Address - Phone:718-658-4050
Mailing Address - Fax:718-658-8910
Practice Address - Street 1:8950 164TH ST
Practice Address - Street 2:STE 2A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5142
Practice Address - Country:US
Practice Address - Phone:718-658-4050
Practice Address - Fax:718-658-8910
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036853122300000X
FLDN0010710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00722770Medicaid
NY036853OtherSTATE BOARD OF EDUCATION
NY036853OtherSTATE BOARD OF EDUCATION