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General NPI Number Information
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NPI Number | 1154886398
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Entity Type | Individual
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Provider Name | SHWAN RAOUF MOHAMMED DDS
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Gender | Male
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 1100 N GATEWAY DR
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City | MADERA
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State | CA
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Zip | 93637-9600
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Country | US
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Telephone | 559-363-4610
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Fax |
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Provider Business Mailing Address
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Address Line | 15555 MAIN ST STE C3
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City | HESPERIA
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State | CA
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Zip | 92345-3423
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Country | US
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Telephone | 619-457-7008
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103494
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License Number State | CA
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