Provider Demographics
NPI:1831781277
Name:SAUD, SYED
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:SAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 QUEENS BLVD APT 6L
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7710
Mailing Address - Country:US
Mailing Address - Phone:203-953-8473
Mailing Address - Fax:
Practice Address - Street 1:8131 BAXTER AVE APT LB
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1316
Practice Address - Country:US
Practice Address - Phone:718-775-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0626881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice