Provider Demographics
NPI:1699920678
Name:ISMAIL, EHAB FAYEK (DDS)
Entity type:Individual
Prefix:
First Name:EHAB
Middle Name:FAYEK
Last Name:ISMAIL
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 1:2641 HAMNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3636
Mailing Address - Country:US
Mailing Address - Phone:562-968-4061
Mailing Address - Fax:
Practice Address - Street 1:2641 HAMNER AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3636
Practice Address - Country:US
Practice Address - Phone:562-968-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47102OtherDENTI-CAL