Provider Demographics
NPI:1396404679
Name:ABOURICHEH, MOHAMED BASSEL
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:BASSEL
Last Name:ABOURICHEH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BASSEL
Other - Middle Name:
Other - Last Name:ABOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13 SNAPDRAGON
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2808
Mailing Address - Country:US
Mailing Address - Phone:949-506-9200
Mailing Address - Fax:
Practice Address - Street 1:13 SNAPDRAGON
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2808
Practice Address - Country:US
Practice Address - Phone:949-506-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist