Provider Demographics
NPI:1104091255
Name:AMMAR, EMAD M (DDS)
Entity type:Individual
Prefix:DR
First Name:EMAD
Middle Name:M
Last Name:AMMAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N PENNSYLVANIA AVE
Mailing Address - Street 2:STE #5
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741
Mailing Address - Country:US
Mailing Address - Phone:626-335-6888
Mailing Address - Fax:626-335-0277
Practice Address - Street 1:175 N PENNSYLVANIA AVE
Practice Address - Street 2:STE #5
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741
Practice Address - Country:US
Practice Address - Phone:626-335-6888
Practice Address - Fax:626-335-0277
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics