Provider Demographics
NPI:1881290112
Name:MERSAL, AHMAD (DDS)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:MERSAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:AHMED
Other - Middle Name:FAHMI YOUSSEF ELSAID
Other - Last Name:MERSAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2008 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1923
Mailing Address - Country:US
Mailing Address - Phone:310-658-1636
Mailing Address - Fax:
Practice Address - Street 1:652 E REGENT ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1415
Practice Address - Country:US
Practice Address - Phone:310-330-0604
Practice Address - Fax:310-330-0590
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist