Provider Demographics
NPI:1407183080
Name:SEIRAWAN, MOUHAMMAD HAZEM (DDS MPH MS)
Entity Type:Individual
Prefix:DR
First Name:MOUHAMMAD
Middle Name:HAZEM
Last Name:SEIRAWAN
Suffix:
Gender:M
Credentials:DDS MPH MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 TANGLEWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:909-613-1144
Mailing Address - Fax:
Practice Address - Street 1:1470 PANTOPS MOUNTAIN PL
Practice Address - Street 2:CHILDREN'S DENTISTRY OF CHARLOTTESVILLE
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4600
Practice Address - Country:US
Practice Address - Phone:434-817-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586711223P0221X
VA0401413688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry