Provider Demographics
NPI:1285876086
Name:BASSIOUNY, MOHAMED A (DMD,MSC,PHD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:BASSIOUNY
Suffix:
Gender:M
Credentials:DMD,MSC,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 EDANN RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-2104
Mailing Address - Country:US
Mailing Address - Phone:215-884-3249
Mailing Address - Fax:
Practice Address - Street 1:1113 EDANN RD
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-2104
Practice Address - Country:US
Practice Address - Phone:215-884-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024349L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist