Provider Demographics
NPI:1487985768
Name:MOHAMED, HIBAQ I (DDS)
Entity type:Individual
Prefix:DR
First Name:HIBAQ
Middle Name:I
Last Name:MOHAMED
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 1:2364 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4086
Mailing Address - Country:US
Mailing Address - Phone:651-334-1667
Mailing Address - Fax:612-659-8690
Practice Address - Street 1:606 24TH AVE S
Practice Address - Street 2:SUITE# 200
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1455
Practice Address - Country:US
Practice Address - Phone:612-659-8689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice