Provider Demographics
NPI:1629737366
Name:HAMOOD, AHMAD JAWAD (DDS)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:JAWAD
Last Name:HAMOOD
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 1:10270 E TARON DR APT 78
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8225
Mailing Address - Country:US
Mailing Address - Phone:415-819-3206
Mailing Address - Fax:
Practice Address - Street 1:9640 BRUCEVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5937
Practice Address - Country:US
Practice Address - Phone:916-686-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist