MEDICARE: AMR ENAYA, DDS, INC

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	261QD0000X	Dental Clinic/Center	48256	CA

General Provider Information

NPI Number	:	1922591528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMR ENAYA, DDS, INC

Provider Business Mailing Address
First Line	:	216 N LINCOLN WAY STE 40
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1715
Country	:	US
Telephone Number	:	209-744-9955
Fax Number	:	209-744-8374

Provider Business Practice Location Address
First Line	:	216 N LINCOLN WAY STE 40
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1715
Country	:	US
Telephone Number	:	209-744-9955
Fax Number	:	209-744-8374

Authorized Official
Title or Position	:	OWNER
Name	:	AMR M ENAYA
Credential	:	DDS
Telephone Number	:	209-744-9955

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	06/08/2018

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