Provider Demographics
NPI:1598347742
Name:KADAMANI, MOHAMAD WALID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:WALID
Last Name:KADAMANI
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 1:372 MCALISTER REFUGE HWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-9797
Mailing Address - Country:US
Mailing Address - Phone:415-941-9059
Mailing Address - Fax:
Practice Address - Street 1:167B CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1278
Practice Address - Country:US
Practice Address - Phone:415-941-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40295122300000X
CADDS106442122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program