Provider Demographics
NPI:1831170430
Name:ALAMZAD, HASSAN MOHAMMAD (DMD)
Entity type:Individual
Prefix:MR
First Name:HASSAN
Middle Name:MOHAMMAD
Last Name:ALAMZAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86-18A 37 AVE
Mailing Address - Street 2:QUEENS PROFESSIONAL
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-898-8080
Mailing Address - Fax:718-898-0422
Practice Address - Street 1:86-18A 37 AVE
Practice Address - Street 2:QUEENS PROFESSIONAL
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-898-8080
Practice Address - Fax:718-898-0422
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01104714Medicaid