Provider Demographics
NPI:1780390914
Name:KACHLAN, MAMDOUH OMAR (DMD, MS, FACP)
Entity type:Individual
Prefix:DR
First Name:MAMDOUH
Middle Name:OMAR
Last Name:KACHLAN
Suffix:
Gender:M
Credentials:DMD, MS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 MESSINA LOOP UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2239
Mailing Address - Country:US
Mailing Address - Phone:267-401-8885
Mailing Address - Fax:
Practice Address - Street 1:2700 S TAMIAMI TRL STE 8
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4528
Practice Address - Country:US
Practice Address - Phone:941-951-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0430961223P0700X
FLDN297881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics