Provider Demographics
NPI:1619941283
Name:NAKHAMIS, RENNA (DDS)
Entity type:Individual
Prefix:
First Name:RENNA
Middle Name:
Last Name:NAKHAMIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 92ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6414
Mailing Address - Country:US
Mailing Address - Phone:718-680-0005
Mailing Address - Fax:718-680-0010
Practice Address - Street 1:544 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6414
Practice Address - Country:US
Practice Address - Phone:718-680-0005
Practice Address - Fax:718-680-0010
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049657-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02207638Medicaid