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General NPI Number Information
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NPI Number | 1710230206
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Entity Type | Individual
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Provider Name | TAREQ AFIFI D.D.S
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Gender | Male
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Dates
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Enumeration Date | 10/21/2012
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 12850 10TH ST SUITE B-1
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City | CHINO
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State | CA
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Zip | 91710-4293
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Country | US
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Telephone | 909-613-0111
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Fax | 909-613-0150
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Provider Business Mailing Address
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Address Line | 7551 DARTMOUTH AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1509
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Country | US
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Telephone | 818-585-2693
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Fax | 909-476-8184
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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 | 61584
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License Number State | CA
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