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General NPI Number Information
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NPI Number | 1871838607
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Entity Type | Organization
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Legal Business Name | CLEVEMORSE FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/05/2012
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 4533 CLEVELAND AVE
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City | COLUMBUS
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State | OH
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Zip | 43231-5850
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Country | US
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Telephone | 703-915-5852
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Fax |
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Provider Business Mailing Address
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Address Line | 4533 CLEVELAND AVE
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City | COLUMBUS
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State | OH
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Zip | 43231
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Country | US
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Telephone | 703-915-5852
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HAMDI O MOHAMED
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Credential | DDS
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Telephone | 703-915-5852
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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 | 30023570
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License Number State | OH
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