Healthcare Provider Details

I. General information

NPI: 1689241838
Provider Name (Legal Business Name): MOUHAMADOU SEYDI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S NEW HOPE RD
GASTONIA NC
28054-4040
US

IV. Provider business mailing address

4015 CRAFT ST APT 5244
CHARLOTTE NC
28217-1690
US

V. Phone/Fax

Practice location:
  • Phone: 980-448-3144
  • Fax:
Mailing address:
  • Phone: 313-427-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number41089
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number14099
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: