Provider Demographics
NPI:1568634624
Name:HOMAYOON, WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:HOMAYOON
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 1:669 LANSON ST
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-3403
Mailing Address - Country:US
Mailing Address - Phone:631-567-4584
Mailing Address - Fax:631-567-3683
Practice Address - Street 1:669 LANSON ST
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3403
Practice Address - Country:US
Practice Address - Phone:631-567-4584
Practice Address - Fax:631-567-3683
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450531223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics