Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24193 | TX |
N | 1223G0001X | General Practice | 24193 | TX |
N | 213EG0000X | General Practice | 24193 | TX |
N | 1223P0106X | Oral and Maxillofacial Pathology | 24193 | TX |
NPI | 1093963357 |
---|---|
Provider Name | Dr. Mohammed Mansour |
First Address | Plano, TX 75074 |
Second Address | Plano, TX 75074-8940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2008 |
Last Update Date | 28/03/2013 |