Provider Demographics
NPI:1871654038
Name:MOHAMED, MAHMOUD ABDELMOHSEN BAHR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:ABDELMOHSEN BAHR
Last Name:MOHAMED
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 1:4826 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4719
Mailing Address - Country:US
Mailing Address - Phone:559-347-1691
Mailing Address - Fax:
Practice Address - Street 1:4826 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4719
Practice Address - Country:US
Practice Address - Phone:559-347-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist