Individual
AHAVA BENSOUSSAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
169 W 133RD ST, NEW YORK, NY 10030-3301
(646) 762-4950
Mailing address
14732 68TH DR, FLUSHING, NY 11367-2060
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/16/2023
Last updated
03/16/2023
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