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General NPI Number Information
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NPI Number | 1275621831
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Entity Type | Individual
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Provider Name | TARIQ HAFEZ ALSAMAAN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 8906 SAN BERNARDINO RD SUITE 130
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8801
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Country | US
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Telephone | 909-758-9200
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Fax | 909-758-9228
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Provider Business Mailing Address
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Address Line | PO BOX 1939
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City | SANTA YNEZ
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State | CA
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Zip | 93460-1939
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Country | US
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Telephone | 805-717-3301
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Fax | 909-758-9228
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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 | 50884
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License Number State | CA
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