Provider Demographics
NPI:1689885261
Name:MOHD AWWAD ,DDS , INC
Entity Type:Organization
Organization Name:MOHD AWWAD ,DDS , INC
Other - Org Name:VICTORIA PLACE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHD
Authorized Official - Middle Name:
Authorized Official - Last Name:AWWAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-443-9374
Mailing Address - Street 1:3144 BROADWAY ST
Mailing Address - Street 2:SUITE C1
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3838
Mailing Address - Country:US
Mailing Address - Phone:707-443-9374
Mailing Address - Fax:707-443-9376
Practice Address - Street 1:3144 BROADWAY ST
Practice Address - Street 2:SUITE C1
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3838
Practice Address - Country:US
Practice Address - Phone:707-443-9374
Practice Address - Fax:707-443-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty