Provider Demographics
NPI:1578961504
Name:LAGUNA SPRINGS DENTAL
Entity Type:Organization
Organization Name:LAGUNA SPRINGS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:MOSTAFA
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-204-0754
Mailing Address - Street 1:9299 LAGUNA SPRINGS DR
Mailing Address - Street 2:#100
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7976
Mailing Address - Country:US
Mailing Address - Phone:209-204-0754
Mailing Address - Fax:
Practice Address - Street 1:9299 LAGUNA SPRINGS DR
Practice Address - Street 2:#100
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7976
Practice Address - Country:US
Practice Address - Phone:209-204-0754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty