Provider Demographics
NPI:1962164939
Name:MEHMOOD, HAMZAH (DMD)
Entity type:Individual
Prefix:DR
First Name:HAMZAH
Middle Name:
Last Name:MEHMOOD
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 1:211 LIBERTY AVE APT 835
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6869
Mailing Address - Country:US
Mailing Address - Phone:973-208-4910
Mailing Address - Fax:
Practice Address - Street 1:5540 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5138
Practice Address - Country:US
Practice Address - Phone:337-247-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA72671223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice