Healthcare Provider Details

I. General information

NPI: 1063270890
Provider Name (Legal Business Name): MOHAMED SAAD ELMESSIRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 SPARKS DR
FOREST CITY NC
28043-9021
US

IV. Provider business mailing address

164 PATRICK MURPHY DR APT 35
MORGANTON NC
28655-4689
US

V. Phone/Fax

Practice location:
  • Phone: 704-284-5174
  • Fax:
Mailing address:
  • Phone: 203-361-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11380
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: