Provider Demographics
NPI:1629324652
Name:AL-JANABI, MOHAMED (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:AL-JANABI
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 1:250 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5000
Mailing Address - Country:US
Mailing Address - Phone:781-999-4109
Mailing Address - Fax:
Practice Address - Street 1:250 SPRING ST
Practice Address - Street 2:APT 18
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:781-999-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL116241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery