Provider Demographics
NPI:1851847917
Name:BLEIBEL, MOHAMMED
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:BLEIBEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8098 WAVERLY XING
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7529
Mailing Address - Country:US
Mailing Address - Phone:901-581-4099
Mailing Address - Fax:
Practice Address - Street 1:230 GOODMAN RD E BLDG 1
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-8318
Practice Address - Country:US
Practice Address - Phone:662-996-2211
Practice Address - Fax:662-996-4909
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3882-16122300000X
TN10329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist