Provider Demographics
NPI:1104800432
Name:SAIDI, WALEED MUGALLY (DDS)
Entity type:Individual
Prefix:MR
First Name:WALEED
Middle Name:MUGALLY
Last Name:SAIDI
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 1:132-41 114 PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420
Mailing Address - Country:US
Mailing Address - Phone:917-582-0402
Mailing Address - Fax:
Practice Address - Street 1:3003 30TH AVE STE 2
Practice Address - Street 2:DENTAL SMILE PC
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2168
Practice Address - Country:US
Practice Address - Phone:917-582-0802
Practice Address - Fax:917-582-0802
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02333080Medicaid