Provider Demographics
NPI:1801949078
Name:NOUR-EL-DEEN, AHMED M (DDS)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:NOUR-EL-DEEN
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 1:845 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4606
Mailing Address - Country:US
Mailing Address - Phone:516-486-1430
Mailing Address - Fax:516-972-8629
Practice Address - Street 1:845 DURHAM RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4606
Practice Address - Country:US
Practice Address - Phone:516-486-1430
Practice Address - Fax:516-972-8629
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01205467Medicaid