Provider Demographics
NPI:1255188496
Name:AL-SHAEBI, MOHAMMED ABDULHAMEED
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ABDULHAMEED
Last Name:AL-SHAEBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CONNER GRANT RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-9595
Mailing Address - Country:US
Mailing Address - Phone:252-626-1683
Mailing Address - Fax:
Practice Address - Street 1:12612 CAPITAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7489
Practice Address - Country:US
Practice Address - Phone:919-435-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC138071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program