Provider Demographics
NPI:1104167824
Name:MOUDED, RAMI (DDS)
Entity type:Individual
Prefix:
First Name:RAMI
Middle Name:
Last Name:MOUDED
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 1:31088 BELLERIVE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1893
Mailing Address - Country:US
Mailing Address - Phone:440-454-4530
Mailing Address - Fax:
Practice Address - Street 1:14865 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3909
Practice Address - Country:US
Practice Address - Phone:216-772-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300214961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice