Provider Demographics
NPI:1184331621
Name:MOHAMMED ALROSHAIDAN, DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MOHAMMED ALROSHAIDAN, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALROSHAIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-836-1202
Mailing Address - Street 1:6580 HEMBREE LN STE 255
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-6885
Mailing Address - Country:US
Mailing Address - Phone:707-836-1202
Mailing Address - Fax:707-836-1253
Practice Address - Street 1:6580 HEMBREE LN STE 255
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-6885
Practice Address - Country:US
Practice Address - Phone:707-836-1202
Practice Address - Fax:707-836-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty