Provider Demographics
NPI:1962564013
Name:GAD, MONA TAHA MOHAMMED (DDS)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:TAHA MOHAMMED
Last Name:GAD
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 1:2775 MESA VERDE DR E
Mailing Address - Street 2:A 103
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4957
Mailing Address - Country:US
Mailing Address - Phone:805-264-5778
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4620
Practice Address - Country:US
Practice Address - Phone:714-973-9006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice