Provider Demographics
NPI:1972372670
Name:MONA A HALEEM DDS PLLC
Entity type:Organization
Organization Name:MONA A HALEEM DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:AMTULLAH
Authorized Official - Last Name:HALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-358-0460
Mailing Address - Street 1:200 WHITE SPRUCE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1605
Mailing Address - Country:US
Mailing Address - Phone:585-358-0460
Mailing Address - Fax:585-358-0461
Practice Address - Street 1:200 WHITE SPRUCE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1605
Practice Address - Country:US
Practice Address - Phone:585-358-0460
Practice Address - Fax:585-358-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty