Provider Demographics
NPI:1013499086
Name:MAHMOUD, SAMMY MOHAMED (MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:MOHAMED
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4564 ETHRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024
Mailing Address - Country:US
Mailing Address - Phone:214-850-6875
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESTON RD STE 310
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3603
Practice Address - Country:US
Practice Address - Phone:972-612-9970
Practice Address - Fax:972-758-0141
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice