Provider Demographics
NPI:1336548536
Name:ALFY, WAEL
Entity type:Individual
Prefix:
First Name:WAEL
Middle Name:
Last Name:ALFY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 WINSTON CT
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4138
Mailing Address - Country:US
Mailing Address - Phone:402-617-9242
Mailing Address - Fax:
Practice Address - Street 1:1513 FREMONT BLVD
Practice Address - Street 2:SUITE E-2
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-4319
Practice Address - Country:US
Practice Address - Phone:831-324-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice