MEDICARE: SAFWAT S GENDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	27427	CA
2	1223G0001X	General Practice Dentistry	27427	CA

General Provider Information

NPI Number	:	1417198284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAFWAT S GENDY

Provider Business Mailing Address
First Line	:	4227 ARTESIA BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-3105
Country	:	US
Telephone Number	:	562-988-8558
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2831
Country	:	US
Telephone Number	:	562-988-8558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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Directions to “ SAFWAT S GENDY ” Practice Location

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