Provider Demographics
NPI:1316911662
Name:AHMAD, MAHMOUD (DDS)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:AHMAD
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 1:2721 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-4616
Mailing Address - Country:US
Mailing Address - Phone:951-925-2226
Mailing Address - Fax:
Practice Address - Street 1:2721 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-4616
Practice Address - Country:US
Practice Address - Phone:951-925-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118911223G0001X
CA581871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN540689700OtherMEDICAL ASSISTANCE NUMBER