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Individual

MERIEM BOUKADOUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
520 2ND AVE, APARTMENT 4C, NEW YORK, NY 10016-8640
(703) 955-0668
Mailing address
520 2ND AVE APT 4C, NEW YORK, NY 10016-8619

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
50057519
NY

Other

Enumeration date
08/21/2014
Last updated
08/21/2014
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