Provider Demographics
NPI:1306536263
Name:HARAJLI, MOHAMED (DMD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:HARAJLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 S MARION ST APT H
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0149
Mailing Address - Country:US
Mailing Address - Phone:313-912-2741
Mailing Address - Fax:
Practice Address - Street 1:26088 WILSON DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-4151
Practice Address - Country:US
Practice Address - Phone:313-912-2741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program