Provider Demographics
NPI:1134648462
Name:MOHAMMED, EMAD N (DBS)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:N
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:DBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 S AIRPORT RD W
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7929
Mailing Address - Country:US
Mailing Address - Phone:231-417-4380
Mailing Address - Fax:
Practice Address - Street 1:3375 S AIRPORT RD W
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7929
Practice Address - Country:US
Practice Address - Phone:231-714-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010221801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice