Provider Demographics
NPI:1689025801
Name:CHARARA, MOHAMAD (DMD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:CHARARA
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 1:29848 FORD RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2365
Mailing Address - Country:US
Mailing Address - Phone:734-522-2180
Mailing Address - Fax:
Practice Address - Street 1:29848 FORD RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2365
Practice Address - Country:US
Practice Address - Phone:734-522-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist