Individual
MOHAMED BAQER HASSAN GHANDOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2100 SUPERIOR ST, ELKHART, IN 46516-4704
(574) 970-1937
Mailing address
1121 W MICHIGAN ST, INDIANAPOLIS, IN 46202-5211
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12014402A
IN
Other
Enumeration date
09/15/2023
Last updated
07/10/2024
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