Provider Demographics
NPI:1104191584
Name:FARAGALLAH, HANY SAMAAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HANY
Middle Name:SAMAAN
Last Name:FARAGALLAH
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 1:2590 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2909
Mailing Address - Country:US
Mailing Address - Phone:800-579-3783
Mailing Address - Fax:
Practice Address - Street 1:2590 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2909
Practice Address - Country:US
Practice Address - Phone:800-579-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist