Provider Demographics
NPI:1578552311
Name:EL DEEB, MOHAMED E (DDS DOS MS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:E
Last Name:EL DEEB
Suffix:
Gender:M
Credentials:DDS DOS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11441 OSAGE ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3677
Mailing Address - Country:US
Mailing Address - Phone:763-862-6442
Mailing Address - Fax:763-862-6444
Practice Address - Street 1:11441 OSAGE ST NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3677
Practice Address - Country:US
Practice Address - Phone:763-862-6442
Practice Address - Fax:763-862-6444
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN95081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN973020600Medicaid
MN973020600Medicaid