1104800432 NPI number — MR. WALEED MUGALLY SAIDI DDS

Table of content: MR. WALEED MUGALLY SAIDI DDS (NPI 1104800432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104800432 NPI number — MR. WALEED MUGALLY SAIDI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAIDI
Provider First Name:
WALEED
Provider Middle Name:
MUGALLY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104800432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132-41 114 PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH OZONE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-582-0402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3003 30TH AVE STE 2
Provider Second Line Business Practice Location Address:
DENTAL SMILE PC
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-582-0802
Provider Business Practice Location Address Fax Number:
917-582-0802
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  050236 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02333080 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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