Provider Demographics
NPI:1952655854
Name:CITY DENTAL CARE JAMAICA P.C.
Entity Type:Organization
Organization Name:CITY DENTAL CARE JAMAICA P.C.
Other - Org Name:MOHAMMAD W BHUYAN DDS (PREVIOUS NAME)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:WADUDUZZAMAN
Authorized Official - Last Name:BHUYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-658-4050
Mailing Address - Street 1:89-50, 164TH STR STE #2A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-658-4050
Mailing Address - Fax:718-658-8910
Practice Address - Street 1:89-50, 164TH STR
Practice Address - Street 2:SUITE - 2A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-658-4050
Practice Address - Fax:718-658-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00722770Medicaid