Provider Demographics
NPI:1073886057
Name:ISMAIL, MOHAMMED (DDS, MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ISMAIL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1326
Mailing Address - Country:US
Mailing Address - Phone:225-953-8315
Mailing Address - Fax:
Practice Address - Street 1:3100 GALLERIA DR STE 202
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2196
Practice Address - Country:US
Practice Address - Phone:504-456-5033
Practice Address - Fax:504-456-5057
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA62731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program