MEDICARE: DR. TARIQ HAFEZ ALSAMAAN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	50884	CA

General Provider Information

NPI Number	:	1275621831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARIQ HAFEZ ALSAMAAN D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 1939
Second Line	:
City	:	SANTA YNEZ
State	:	CA
Zip	:	93460-1939
Country	:	US
Telephone Number	:	805-717-3301
Fax Number	:	909-758-9228

Provider Business Practice Location Address
First Line	:	8906 SAN BERNARDINO RD
Second Line	:	SUITE 130
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-8801
Country	:	US
Telephone Number	:	909-758-9200
Fax Number	:	909-758-9228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	04/15/2011

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