Healthcare Provider Details

I. General information

NPI: 1235407107
Provider Name (Legal Business Name): SAWSAN MOHAMED SALIH BDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S PARK DR
BROWNWOOD TX
76801-5918
US

IV. Provider business mailing address

1100 W REYNOSA AVE
DE LEON TX
76444-1630
US

V. Phone/Fax

Practice location:
  • Phone: 325-646-0704
  • Fax: 866-810-6631
Mailing address:
  • Phone: 325-646-0704
  • Fax: 866-810-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31850
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: