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General NPI Number Information
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NPI Number | 1790279628
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Entity Type | Organization
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Legal Business Name | BOU MJAHED,DDS,PLLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 328 W CARSON BLVD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28203-4024
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Country | US
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Telephone | 704-277-6718
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Fax |
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Provider Business Mailing Address
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Address Line | 328 W CARSON BLVD STE 100
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City | CHARLOTTE
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State | NC
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Zip | 28203-4024
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Country | US
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Telephone | 704-277-6718
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. KHALIL MJAHED
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Credential | DDS
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Telephone | 704-277-6718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9511
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License Number State | NC
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