Provider Demographics
NPI:1093830721
Name:HOMSI, MOHAMAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:
Last Name:HOMSI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MOHAMAD
Other - Middle Name:
Other - Last Name:HOMSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD,DDS
Mailing Address - Street 1:7 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3502
Mailing Address - Country:US
Mailing Address - Phone:617-242-9200
Mailing Address - Fax:
Practice Address - Street 1:7 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3502
Practice Address - Country:US
Practice Address - Phone:617-242-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0279269Medicaid