Provider Demographics
NPI:1649007402
Name:MOHAMMED, WEDYAN (DDS)
Entity type:Individual
Prefix:
First Name:WEDYAN
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 STONE ARBOR LN APT 727
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7605
Mailing Address - Country:US
Mailing Address - Phone:603-486-1675
Mailing Address - Fax:
Practice Address - Street 1:3400 HAYDENPARK LN STE 203
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7867
Practice Address - Country:US
Practice Address - Phone:804-390-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist