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General NPI Number Information
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NPI Number | 1154872406
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Entity Type | Organization
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Legal Business Name | CAPITAL FAMILY DENTAL GROUP
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 3000 L ST STE 205
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City | SACRAMENTO
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State | CA
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Zip | 95816-5248
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Country | US
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Telephone | 916-452-1884
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Fax | 916-452-1885
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Provider Business Mailing Address
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Address Line | 3000 L ST STE 205
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City | SACRAMENTO
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State | CA
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Zip | 95816-5248
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Country | US
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Telephone | 916-452-1884
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Fax | 916-452-1885
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Authorized Official
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Title or Position | DDS
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Name | AYMAN MOHAMED GHOBASHY
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Credential | DENTIST
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Telephone | 916-802-2079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 49530
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License Number State | CA
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