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General NPI Number Information
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NPI Number | 1093963357
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Entity Type | Individual
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Provider Name | MOHAMMED MANSOUR BDS, MS
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Gender | Male
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 3305 MOSSWOOD DR
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City | PLANO
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State | TX
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Zip | 75074-8940
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Country | US
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Telephone | 469-230-7338
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 MOSSWOOD DR
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City | PLANO
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State | TX
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Zip | 75074
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Country | US
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Telephone | 469-230-7338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 24193
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24193
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 24193
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License Number State | TX
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