Provider Demographics
NPI:1902496359
Name:GHANEM, MOHAMED ABDEL HAKIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ABDEL HAKIM
Last Name:GHANEM
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 1:2201 N URSULA ST APT 308
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-7439
Mailing Address - Country:US
Mailing Address - Phone:718-309-9275
Mailing Address - Fax:
Practice Address - Street 1:8721 TURNPIKE DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7046
Practice Address - Country:US
Practice Address - Phone:303-657-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002046271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice