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General NPI Number Information
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NPI Number | 1790638518
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Entity Type | Individual
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Provider Name | BADRADDIN MANSOUR MOHAMAD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2026
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Last Update Date | 02/19/2026
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Provider Practice Location Address
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Address Line | 1280 CONCORD AVE
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City | RICHMOND
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State | VA
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Zip | 23228-6518
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Country | US
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Telephone | 804-261-4871
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Fax |
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Provider Business Mailing Address
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Address Line | 125 BARNOSKY CT APT 125
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City | SOUTH PLAINFIELD
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State | NJ
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Zip | 07080-2538
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Country | US
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Telephone | 407-881-3323
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0401419887
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License Number State | VA
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