Provider Demographics
NPI:1063144491
Name:DIMYAN, ANTONIOUS ATEF (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIOUS
Middle Name:ATEF
Last Name:DIMYAN
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 1:14627 REEVES AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1220
Mailing Address - Country:US
Mailing Address - Phone:917-569-7070
Mailing Address - Fax:
Practice Address - Street 1:9 MIDDLETOWN LINCROFT RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1511
Practice Address - Country:US
Practice Address - Phone:732-842-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02902400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist