Provider Demographics
NPI:1821573551
Name:ALKURDI, MOHAMMAD MANAF (DMD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD MANAF
Middle Name:
Last Name:ALKURDI
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 1:5 BENEFIT ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2762
Mailing Address - Country:US
Mailing Address - Phone:401-521-3822
Mailing Address - Fax:
Practice Address - Street 1:5 BENEFIT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2762
Practice Address - Country:US
Practice Address - Phone:401-521-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18581211223G0001X
RIDEN034221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice