Provider Demographics
NPI:1356834048
Name:EBN ALNASSIR, MOHAMMAD ALI (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD ALI
Middle Name:
Last Name:EBN ALNASSIR
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 1:7156 RACINE WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-8422
Mailing Address - Country:US
Mailing Address - Phone:919-817-0715
Mailing Address - Fax:
Practice Address - Street 1:3769 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3327
Practice Address - Country:US
Practice Address - Phone:252-443-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice