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General NPI Number Information
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NPI Number | 1891707428
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Entity Type | Individual
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Provider Name | MOHAMED A MAKSOUD DMD PA
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 10 NOUVELLE WAY UNIT T926
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City | NATICK
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State | MA
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Zip | 01760-1593
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Country | US
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Telephone | 904-434-9692
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Fax |
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Provider Business Mailing Address
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Address Line | 10 NOUVELLE WAY UNIT T926
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City | NATICK
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State | MA
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Zip | 01760-1593
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Country | US
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Telephone | 904-434-9692
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12016
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN12016
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 254685
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License Number State | MA
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