Provider Demographics
NPI:1194151449
Name:ELNAHASS, MOHAMED (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:ELNAHASS
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 1:200 EXECUTIVE CENTER PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3177
Mailing Address - Country:US
Mailing Address - Phone:540-373-1641
Mailing Address - Fax:540-373-7718
Practice Address - Street 1:200 EXECUTIVE CENTER PKWY STE 104
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-373-1641
Practice Address - Fax:540-373-7718
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02545800122300000X
IL019029670122300000X
NH04040122300000X
VA0401415268122300000X
FLDN20358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist