Provider Demographics
NPI:1871223792
Name:AHMED, MOHAMMED MOEEDUDDIN (BDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:MOEEDUDDIN
Last Name:AHMED
Suffix:
Gender:M
Credentials:BDS, MDS
Other - Prefix:
Other - First Name:MOHD
Other - Middle Name:MOEEDUDDIN
Other - Last Name:AHMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 GREENWICH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2202
Mailing Address - Country:US
Mailing Address - Phone:331-980-2703
Mailing Address - Fax:
Practice Address - Street 1:61 PINE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1043
Practice Address - Country:US
Practice Address - Phone:802-453-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT019.01340531223X2210X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X2210XDental ProvidersDentistOrofacial Pain
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6710467Medicaid