Provider Demographics
NPI:1962062125
Name:SOBH, MOHAMMED (DDS)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:SOBH
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 1:1849 N DENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1156
Mailing Address - Country:US
Mailing Address - Phone:313-663-6484
Mailing Address - Fax:
Practice Address - Street 1:14639 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3173
Practice Address - Country:US
Practice Address - Phone:313-582-1960
Practice Address - Fax:313-582-2414
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016001621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI841864781Medicaid