Provider Demographics
NPI:1093963357
Name:MANSOUR, MOHAMMED (BDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:469-230-7338
Mailing Address - Fax:
Practice Address - Street 1:3305 MOSSWOOD DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8940
Practice Address - Country:US
Practice Address - Phone:469-230-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24193122300000X, 1223G0001X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology