Provider Demographics
NPI:1295059152
Name:RESHAD, MOHAMAD ALI (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:ALI
Last Name:RESHAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151S HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-7792
Mailing Address - Country:US
Mailing Address - Phone:213-740-7405
Mailing Address - Fax:
Practice Address - Street 1:3151S HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-7792
Practice Address - Country:US
Practice Address - Phone:213-740-7405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice