Provider Demographics
NPI:1093094955
Name:MOHAMED GHOUSE MOHIDEEN, HASEENA (DDS)
Entity type:Individual
Prefix:DR
First Name:HASEENA
Middle Name:
Last Name:MOHAMED GHOUSE MOHIDEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 GEORGIAN CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2534
Mailing Address - Country:US
Mailing Address - Phone:732-725-2064
Mailing Address - Fax:
Practice Address - Street 1:2169 ROUTE 94
Practice Address - Street 2:
Practice Address - City:SALISBURY MILLS
Practice Address - State:NY
Practice Address - Zip Code:12577-5207
Practice Address - Country:US
Practice Address - Phone:732-725-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY556881223G0001X
NY05568811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice