Basic Information
| Provider Information | |||||||||
| NPI: | 1578053039 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADHAMI | ||||||||
| FirstName: | ARIK | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 HEATHER HILL RD | ||||||||
| Address2: | |||||||||
| City: | GLEN HEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115452604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165470105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100297491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124236271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2018 | ||||||||
| LastUpdateDate: | 11/14/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223G0001X | 060652 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.