Provider Demographics
NPI:1326190117
Name:MOHAMED, RAWIA FAHMY (DDS DIPLOMATE OF THE)
Entity Type:Individual
Prefix:MRS
First Name:RAWIA
Middle Name:FAHMY
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:DDS DIPLOMATE OF THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-254-8240
Mailing Address - Fax:631-254-8214
Practice Address - Street 1:1005 COMMACK RD
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-254-8240
Practice Address - Fax:631-254-8214
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0454421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540541Medicaid