Provider Demographics
NPI:1639231962
Name:YAGHI, MOHAMMAD M (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:M
Last Name:YAGHI
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 1:8220 UNIVERSITY EXECUTIVE PARK DRIVE
Mailing Address - Street 2:110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-547-8783
Mailing Address - Fax:704-510-2530
Practice Address - Street 1:8220 UNIVERSITY EXECUTIVE PARK DRIVE
Practice Address - Street 2:110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-547-8783
Practice Address - Fax:704-510-2530
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90063OtherBLUE CROSS BLUE SHIELD OF
NC7990063Medicaid