Healthcare Provider Details

I. General information

NPI: 1558749457
Provider Name (Legal Business Name): SARAT MOHAMMADU D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E WEST HWY APT 418
SILVER SPRING MD
20910-3270
US

IV. Provider business mailing address

1220 E WEST HWY APT 418
SILVER SPRING MD
20910-3270
US

V. Phone/Fax

Practice location:
  • Phone: 678-266-7377
  • Fax:
Mailing address:
  • Phone: 678-266-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10565
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: