DR. Mohammed Mansoorul Imam, DDS

NPI #1598754947 in Elmhurst, New York

Provider Information

NPI Number: 1598754947
Entity Type: Individual
Name: DR. Mohammed Mansoorul Imam, DDS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Credential: DDS
Enumeration Date: Oct 18, 2005
Last Updated: Nov 12, 2010

Practice Location

Address: 5611 94TH ST
Address 2: SUITE # LN
City: Elmhurst
State: New York
ZIP Code: 11373-5080
Phone: (718) 271-4424

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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