Provider Demographics
NPI:1629304753
Name:MOHIUDDIN, SHAHID MOHAMMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:MOHAMMED
Last Name:MOHIUDDIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3811
Mailing Address - Country:US
Mailing Address - Phone:610-543-4900
Mailing Address - Fax:
Practice Address - Street 1:515 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3811
Practice Address - Country:US
Practice Address - Phone:610-543-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0380811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice