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General NPI Number Information
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NPI Number | 1356563084
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Entity Type | Organization
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Legal Business Name | S GEWAID DDS, PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 470 N. 3RD AVE.
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City | UPLAND
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State | CA
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Zip | 91786-4703
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Country | US
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Telephone | 909-982-9800
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Fax | 909-982-8500
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Provider Business Mailing Address
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Address Line | 470 N. 3RD AVE.
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-982-9800
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Fax | 909-982-8500
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHENOUDA FATHY GEWAID
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Credential | DDS
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Telephone | 909-982-9800
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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 | 49753
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License Number State | CA
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