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General NPI Number Information
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NPI Number | 1801923800
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Entity Type | Organization
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Legal Business Name | YEHIA IMAM, DDS PC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 2034 E SOUTHERN AVE SUITE A
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City | TEMPE
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State | AZ
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Zip | 85282-7522
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Country | US
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Telephone | 480-775-8056
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Fax | 480-775-8064
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Provider Business Mailing Address
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Address Line | 4939 W. RAY RD. 4321
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City | CHANDLER
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State | AZ
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Zip | 85226-2065
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Country | US
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Telephone | 480-775-8056
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Fax | 480-775-8064
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Authorized Official
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Title or Position | PRESIDENT
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Name | YEHIA ALY IMAM
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Credential | DDS
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Telephone | 480-775-8056
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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 | D3255
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License Number State | AZ
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