Provider Demographics
NPI:1952555237
Name:RIAD, MOHAMED EZZ EL-DIN HASSAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:EZZ EL-DIN HASSAN
Last Name:RIAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 CROWN BENCH CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-4607
Mailing Address - Country:US
Mailing Address - Phone:310-908-8784
Mailing Address - Fax:
Practice Address - Street 1:4661 PRECISSI LN STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6206
Practice Address - Country:US
Practice Address - Phone:209-478-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice