Healthcare Provider Details

I. General information

NPI: 1255107850
Provider Name (Legal Business Name): MOHAMED HABIB AHMED TAHA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S WILLOW ST
MANCHESTER NH
03103-4035
US

IV. Provider business mailing address

1111 S WILLOW ST
MANCHESTER NH
03103-4035
US

V. Phone/Fax

Practice location:
  • Phone: 603-210-4416
  • Fax:
Mailing address:
  • Phone: 603-210-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number05346
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL15958
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL16005
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: