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General NPI Number Information
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NPI Number | 1013432913
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Entity Type | Individual
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Provider Name | SAMAN GHAEMMAGHAMI DMD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 4016 UNIVERSITY PKWY
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-1821
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Country | US
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Telephone | 909-880-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 11540 CLARIDGE DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 101529
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License Number State | CA
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