Provider Demographics
NPI:1760580419
Name:AHMED, MOHAMED HASSAN (DMD, DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:HASSAN
Last Name:AHMED
Suffix:
Gender:M
Credentials:DMD, DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1604
Mailing Address - Country:US
Mailing Address - Phone:304-523-0805
Mailing Address - Fax:
Practice Address - Street 1:9840 W BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4199
Practice Address - Country:US
Practice Address - Phone:804-270-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014113181223G0001X
WV3133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9181303Medicaid