Basic Information
| Provider Information | |||||||||
| NPI: | 1538556329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELMOHD | ||||||||
| FirstName: | TARIK | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18209 COLLRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336472912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135281787 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10427 SHELDON RD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336265110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133027126 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | DN23977 | FL | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.