Healthcare Provider Details

I. General information

NPI: 1366857518
Provider Name (Legal Business Name): HUSSAM AHMED D.M.D, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HIGHWAY 274
CLOVER SC
29710-6045
US

IV. Provider business mailing address

4425 SHARON RD UNIT M516
CHARLOTTE NC
28211-4526
US

V. Phone/Fax

Practice location:
  • Phone: 803-752-0565
  • Fax:
Mailing address:
  • Phone: 571-344-8468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number11298
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: