Provider Demographics
NPI:1902210842
Name:SPOUH, MOHAMMAD AHMAD (DDS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AHMAD
Last Name:SPOUH
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 1:17929 TROPICAL COVE DR
Mailing Address - Street 2:NONE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3672
Mailing Address - Country:US
Mailing Address - Phone:317-493-6295
Mailing Address - Fax:
Practice Address - Street 1:7950 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4304
Practice Address - Country:US
Practice Address - Phone:813-715-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 206691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice