Provider Demographics
NPI:1063270890
Name:ELMESSIRY, MOHAMED SAAD
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:SAAD
Last Name:ELMESSIRY
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 1:164 PATRICK MURPHY DR APT 35
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4689
Mailing Address - Country:US
Mailing Address - Phone:203-361-8550
Mailing Address - Fax:
Practice Address - Street 1:176 SPARKS DR
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-9021
Practice Address - Country:US
Practice Address - Phone:704-284-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC138811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program