Provider Demographics
NPI:1932740263
Name:ELDAFRAWY, MAHMOUD (DMD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ELDAFRAWY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-1304
Mailing Address - Country:US
Mailing Address - Phone:774-425-0613
Mailing Address - Fax:
Practice Address - Street 1:137 HATHAWAY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-1304
Practice Address - Country:US
Practice Address - Phone:774-425-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859522122300000X, 1223G0001X
VT016.01339201223G0001X
MI29016012641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist