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General NPI Number Information
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NPI Number | 1366616880
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Entity Type | Individual
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Provider Name | HANI A MAHGOUB D.D.S., M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 2407 PLANTATION CENTER DR STE 102
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City | MATTHEWS
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State | NC
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Zip | 28105-6614
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Country | US
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Telephone | 704-408-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 PLANTATION CENTER DR STE 102
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City | MATTHEWS
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State | NC
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Zip | 28105-6614
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Country | US
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Telephone | 704-246-6557
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Fax | 888-972-1668
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2015-00815
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License Number State | NC
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