Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D010749 | AZ |
NPI | 1376151860 |
---|---|
Provider Name | Saif Ghanem |
First Address | Phoenix, AZ 85032-8029 |
Second Address | Phoenix, AZ 85020-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 21/07/2020 |