Provider Demographics
NPI:1245994953
Name:MOHAMED & ASSOCIATES DDS PA I
Entity type:Organization
Organization Name:MOHAMED & ASSOCIATES DDS PA I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-549-3330
Mailing Address - Street 1:1609 W ARLINGTON BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5610
Mailing Address - Country:US
Mailing Address - Phone:252-321-8580
Mailing Address - Fax:252-321-8582
Practice Address - Street 1:1609 W ARLINGTON BLVD STE 107
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5610
Practice Address - Country:US
Practice Address - Phone:252-321-8580
Practice Address - Fax:252-321-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950786Medicaid