Provider Demographics
NPI:1154844298
Name:KADHEM, MOHAMMED A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:A
Last Name:KADHEM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 S BOND AVE APT 229
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4667
Mailing Address - Country:US
Mailing Address - Phone:818-442-7332
Mailing Address - Fax:
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 354
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3027
Practice Address - Country:US
Practice Address - Phone:619-202-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11734122300000X
WADE61450268122300000X
CA101609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist