Healthcare Provider Details

I. General information

NPI: 1235802497
Provider Name (Legal Business Name): AMAR MAHDI DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 07/25/2021
Certification Date: 07/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9141 E STOCKTON BLVD STE 230
ELK GROVE CA
95624-9502
US

IV. Provider business mailing address

3025 BEARDSLEY WAY
ROSEVILLE CA
95661-2533
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-4998
  • Fax:
Mailing address:
  • Phone: 505-615-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMAR MAHDI
Title or Position: DENTIST
Credential: DDS
Phone: 505-615-4998