Provider Demographics
NPI:1194246702
Name:MOHAMMED ABDUL, MOIZ (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:MOIZ
Middle Name:
Last Name:MOHAMMED ABDUL
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOWARD DR APT T
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-5427
Mailing Address - Country:US
Mailing Address - Phone:1201-300-7144
Mailing Address - Fax:
Practice Address - Street 1:1641 NILE DR
Practice Address - Street 2:APT - 223
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-7841
Practice Address - Country:US
Practice Address - Phone:361-854-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist