Provider Demographics
NPI:1447757968
Name:MEGHIL, MOHAMED (BDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:MEGHIL
Suffix:
Gender:M
Credentials:BDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:OFFICE #416
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-0001
Mailing Address - Country:US
Mailing Address - Phone:313-494-6700
Mailing Address - Fax:
Practice Address - Street 1:2700 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:OFFICE #416
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-0001
Practice Address - Country:US
Practice Address - Phone:313-494-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF0004451223P0300X
MI29016011301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003257537AMedicaid