Provider Demographics
NPI:1275341893
Name:HAFEZ AND GHONEIM DENTAL CORP
Entity type:Organization
Organization Name:HAFEZ AND GHONEIM DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EMAN
Authorized Official - Middle Name:ABDELMOTTI
Authorized Official - Last Name:GHONEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-926-0001
Mailing Address - Street 1:4850 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4111
Mailing Address - Country:US
Mailing Address - Phone:916-926-0001
Mailing Address - Fax:
Practice Address - Street 1:1420 E ROSEVILLE PKWY STE 230
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3081
Practice Address - Country:US
Practice Address - Phone:916-926-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAFEZ AND GHONEIM DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental