Provider Demographics
NPI:1801588769
Name:RABAH, MOHAMAD HASSAN (BDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD HASSAN
Middle Name:
Last Name:RABAH
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 S STATE HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5920
Mailing Address - Country:US
Mailing Address - Phone:972-693-5284
Mailing Address - Fax:
Practice Address - Street 1:450 GARRISONVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1615
Practice Address - Country:US
Practice Address - Phone:540-720-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist