Provider Demographics
NPI:1336412246
Name:MASOUD, MOHAMED I (BDS, DMSC)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:I
Last Name:MASOUD
Suffix:
Gender:M
Credentials:BDS, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3390
Mailing Address - Country:US
Mailing Address - Phone:703-241-9191
Mailing Address - Fax:
Practice Address - Street 1:311 PARK AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3390
Practice Address - Country:US
Practice Address - Phone:703-241-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL113581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics