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General NPI Number Information
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NPI Number | 1982890182
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Entity Type | Organization
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Legal Business Name | DEL MAR FAMILY DENTAL
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 702 S DEL MAR AVE STE A
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City | SAN GABRIEL
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State | CA
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Zip | 91776-2440
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Country | US
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Telephone | 626-287-9781
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Fax | 626-287-4208
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Provider Business Mailing Address
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Address Line | 702 S DEL MAR AVE STE A
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City | SAN GABRIEL
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State | CA
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Zip | 91776-2440
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Country | US
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Telephone | 626-287-9781
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Fax | 626-287-4208
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GAMAL TAYAB
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Credential | D.D.S.
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Telephone | 626-287-9781
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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 | 31987
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License Number State | CA
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