Provider Demographics
NPI:1972778561
Name:DENTAL CENTER OF AMERICA, PC
Entity Type:Organization
Organization Name:DENTAL CENTER OF AMERICA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-229-2205
Mailing Address - Street 1:1521 NORTHWAY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4489
Mailing Address - Country:US
Mailing Address - Phone:320-229-2205
Mailing Address - Fax:320-229-2207
Practice Address - Street 1:1521 NORTHWAY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4489
Practice Address - Country:US
Practice Address - Phone:320-229-2205
Practice Address - Fax:320-229-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12186261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental