Healthcare Provider Details

I. General information

NPI: 1376151860
Provider Name (Legal Business Name): SAIF GHANEM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9242 N 7TH ST
PHOENIX AZ
85020-2502
US

IV. Provider business mailing address

18416 N CAVE CREEK RD APT 2052
PHOENIX AZ
85032-8029
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-7297
  • Fax:
Mailing address:
  • Phone: 734-272-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD010749
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: