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General NPI Number Information
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NPI Number | 1932188679
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Entity Type | Individual
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Provider Name | MOHAMED Y MOHAMED BDS
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 611 SINGLETON AVE
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City | TITUSVILLE
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State | FL
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Zip | 32796
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Country | US
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Telephone | 321-383-5115
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 N COURTENAY PKWY
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4126
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Country | US
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Telephone | 321-454-7148
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Fax | 321-449-5015
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN9466
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License Number State | FL
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