Provider Demographics
NPI:1154186740
Name:SHARAFELDIEN, MOHAMMED (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:SHARAFELDIEN
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 1:12805 CLAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7708
Mailing Address - Country:US
Mailing Address - Phone:317-441-3744
Mailing Address - Fax:
Practice Address - Street 1:1702 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1033
Practice Address - Country:US
Practice Address - Phone:765-362-5100
Practice Address - Fax:765-362-5717
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014325A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty