MEDICARE: DR. MOHAMED SACCOH D. D. S

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
1	1223G0001X	General Practice Dentistry	13055	MD

General Provider Information

NPI Number	:	1770541971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMED SACCOH D. D. S

Provider Business Mailing Address
First Line	:	1203 BRIAR POST CT
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21015-5855
Country	:	US
Telephone Number	:	410-838-9675
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 PULASKI HWY
Second Line	:
City	:	JOPPA
State	:	MD
Zip	:	21085-3625
Country	:	US
Telephone Number	:	410-679-4500
Fax Number	:	410-679-4445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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