Healthcare Provider Details

I. General information

NPI: 1760580419
Provider Name (Legal Business Name): MOHAMED HASSAN AHMED DMD, DDS, FAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9840 W BROAD ST STE B
GLEN ALLEN VA
23060-4199
US

IV. Provider business mailing address

220 13TH ST
HUNTINGTON WV
25701-1604
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-9989
  • Fax:
Mailing address:
  • Phone: 304-523-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3133
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401411318
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: