Provider Demographics
NPI:1285909598
Name:MOHAMED, TASNEIM A (DDS)
Entity type:Individual
Prefix:
First Name:TASNEIM
Middle Name:A
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 REGAL ROSE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:210-984-0361
Mailing Address - Fax:
Practice Address - Street 1:3574 HARTSEL DR
Practice Address - Street 2:UNIT C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2108
Practice Address - Country:US
Practice Address - Phone:719-266-9868
Practice Address - Fax:719-266-0889
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106801223G0001X
TX277851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice