Provider Demographics
NPI:1558684365
Name:AHMED, MOHAMED HAFEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:HAFEZ
Last Name:AHMED
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 1:8760 CENTER PKWY
Mailing Address - Street 2:# C-309
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8438
Mailing Address - Country:US
Mailing Address - Phone:916-230-1183
Mailing Address - Fax:
Practice Address - Street 1:645 W OLIVE AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2433
Practice Address - Country:US
Practice Address - Phone:209-722-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist