Healthcare Provider Details

I. General information

NPI: 1982096798
Provider Name (Legal Business Name): M H AHMED DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
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

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

V. Phone/Fax

Practice location:
  • Phone: 804-270-9989
  • Fax: 804-270-9296
Mailing address:
  • Phone: 804-270-9989
  • Fax: 804-270-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0401411318
License Number StateVA

VIII. Authorized Official

Name: DR. MOHAMED HASSAN AHMED
Title or Position: BUSINESS OWNER
Credential: DMD
Phone: 804-270-9989