Provider Demographics
NPI:1851504112
Name:DOWAIDARI, MOHAMED KAYS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:KAYS
Last Name:DOWAIDARI
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 1:19531 E CIENEGA AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-4015
Mailing Address - Country:US
Mailing Address - Phone:310-709-9849
Mailing Address - Fax:
Practice Address - Street 1:19531 E CIENEGA AVE APT 209
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-4015
Practice Address - Country:US
Practice Address - Phone:310-709-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist