Provider Demographics
NPI:1548302417
Name:KHANDAKAR, MUSLIMA JASMINE (DMD)
Entity type:Individual
Prefix:
First Name:MUSLIMA
Middle Name:JASMINE
Last Name:KHANDAKAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19014 MCLAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1142
Mailing Address - Country:US
Mailing Address - Phone:718-464-3534
Mailing Address - Fax:718-526-6646
Practice Address - Street 1:16701 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4289
Practice Address - Country:US
Practice Address - Phone:718-526-5999
Practice Address - Fax:718-526-6646
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0488631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109479Medicaid