Provider Demographics
NPI:1841902384
Name:ALDAQQA, MOHAMMED
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:ALDAQQA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 EL CAJON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7823
Mailing Address - Country:US
Mailing Address - Phone:619-825-7779
Mailing Address - Fax:
Practice Address - Street 1:7557 EL CAJON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7823
Practice Address - Country:US
Practice Address - Phone:619-825-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist