Provider Demographics
NPI:1891707428
Name:MAKSOUD, MOHAMED A (DMD PA)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:A
Last Name:MAKSOUD
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NOUVELLE WAY UNIT T926
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1593
Mailing Address - Country:US
Mailing Address - Phone:904-434-9692
Mailing Address - Fax:
Practice Address - Street 1:10 NOUVELLE WAY UNIT T926
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1593
Practice Address - Country:US
Practice Address - Phone:904-434-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL120161223P0300X
FLDN120161223P0300X
MA2546851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics