Individual
ABIGAIL JACKIE MOHAMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2327 SW 4TH AVE, ONTARIO, OR 97914-1851
(541) 889-0052
(541) 889-0990
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9279
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D10309
OR
1223G0001X
General Practice Dentistry
Primary
D10309
OR
1223G0001X
General Practice Dentistry
D4685
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500693428
—
OR
Enumeration date
08/04/2015
Last updated
01/14/2026
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