Provider Demographics
NPI:1225170517
Name:BUDEIR, MOUHANNAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOUHANNAD
Middle Name:
Last Name:BUDEIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:983 PEACHTREE PARKWAY SUITE C
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7163
Mailing Address - Country:US
Mailing Address - Phone:770-888-4444
Mailing Address - Fax:770-888-4448
Practice Address - Street 1:983 PEACHTREE PARKWAY SUITE C
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7163
Practice Address - Country:US
Practice Address - Phone:770-888-4444
Practice Address - Fax:770-888-4448
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice