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General NPI Number Information
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NPI Number | 1407542764
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Entity Type | Individual
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Provider Name | GHEDI ABDULAZIZ MOHAMED
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Gender | Male
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 3501 TOWNE CROSSING BLVD STE 180
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City | MESQUITE
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State | TX
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Zip | 75150-2798
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Country | US
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Telephone | 972-270-6646
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Fax |
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Provider Business Mailing Address
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Address Line | 2712 ALMANZOR AVE
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City | IRVING
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State | TX
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Zip | 75062-5372
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Country | US
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Telephone | 682-413-0720
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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 | 41671
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License Number State | TX
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