Provider Demographics
NPI:1154886398
Name:MOHAMMED, SHWAN RAOUF (DDS)
Entity type:Individual
Prefix:
First Name:SHWAN
Middle Name:RAOUF
Last Name:MOHAMMED
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 1:15555 MAIN ST STE C3
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3423
Mailing Address - Country:US
Mailing Address - Phone:619-457-7008
Mailing Address - Fax:
Practice Address - Street 1:1100 N GATEWAY DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-9600
Practice Address - Country:US
Practice Address - Phone:559-363-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103494Medicaid