Provider Demographics
NPI:1770101131
Name:MAHMUD, FATIMA (DMD)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:MAHMUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1407
Mailing Address - Country:US
Mailing Address - Phone:631-878-4488
Mailing Address - Fax:
Practice Address - Street 1:110 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1407
Practice Address - Country:US
Practice Address - Phone:631-878-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362701223G0001X
GADN0161231223G0001X
NY062872122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice