Provider Demographics
NPI:1932748977
Name:MONA, MAHMOUD (DMD)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:MONA
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 1:8414 SW 73RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8471
Mailing Address - Country:US
Mailing Address - Phone:904-738-1049
Mailing Address - Fax:
Practice Address - Street 1:7134 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1974
Practice Address - Country:US
Practice Address - Phone:773-736-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035017122300000X
FLDN24642122300000X, 1223E0200X
IL021.0033271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist