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NPI Code Detail

MEDICARE: DR. MOHAMAD ALI RESHAD DDS

MEDICARE: DR. MOHAMAD ALI RESHAD DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDE00011096WA

General Provider Information

NPI Number : 1295059152
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMAD ALI RESHAD DDS
Provider Business Mailing Address
First Line : 3151S HOOVER ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90089-7792
Country : US
Telephone Number : 213-740-7405
Fax Number :
Provider Business Practice Location Address
First Line : 3151S HOOVER ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90089-7792
Country : US
Telephone Number : 213-740-7405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2010
Last Update Date : 03/22/2010

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