Provider Demographics
NPI:1437590270
Name:MOHAMED, SHIRWAC (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRWAC
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 STATE ROUTE 256
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3261
Mailing Address - Country:US
Mailing Address - Phone:380-224-6387
Mailing Address - Fax:614-504-0409
Practice Address - Street 1:2058 STATE ROUTE 256
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3261
Practice Address - Country:US
Practice Address - Phone:380-224-6387
Practice Address - Fax:614-504-0409
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4292122300000X
OH30.0255601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist