Provider Demographics
NPI:1609035427
Name:DWIDAR, MEDHAT MONGY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEDHAT
Middle Name:MONGY
Last Name:DWIDAR
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:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01202-4699
Mailing Address - Country:US
Mailing Address - Phone:413-445-6680
Mailing Address - Fax:413-443-3680
Practice Address - Street 1:788 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8237
Practice Address - Country:US
Practice Address - Phone:413-445-6680
Practice Address - Fax:413-443-3680
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist