Provider Demographics
NPI:1972822823
Name:MOHSEN, ALAA (BDS, MS, MPH)
Entity type:Individual
Prefix:DR
First Name:ALAA
Middle Name:
Last Name:MOHSEN
Suffix:
Gender:F
Credentials:BDS, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3817
Mailing Address - Country:US
Mailing Address - Phone:201-216-9901
Mailing Address - Fax:
Practice Address - Street 1:3000 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3817
Practice Address - Country:US
Practice Address - Phone:201-216-9901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60060281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist