Healthcare Provider Details

I. General information

NPI: 1336642677
Provider Name (Legal Business Name): HAFEZ AND GHONEIM DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MARCONI AVE
CARMICHAEL CA
95608-4111
US

IV. Provider business mailing address

1009 EASTERN AVE
SACRAMENTO CA
95864-5305
US

V. Phone/Fax

Practice location:
  • Phone: 916-926-0001
  • Fax: 916-926-0002
Mailing address:
  • Phone: 916-753-9359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMED HAFEZ AHMED
Title or Position: PRESIDENT
Credential: DDS
Phone: 916-753-9359