Provider Demographics
NPI:1245425255
Name:WAHBA, MAGED FARES (DDS)
Entity Type:Individual
Prefix:
First Name:MAGED
Middle Name:FARES
Last Name:WAHBA
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 1:7120 HAYVENHURST AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:818-988-1642
Mailing Address - Fax:818-988-0771
Practice Address - Street 1:7120 HAYVENHURST AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:818-988-1642
Practice Address - Fax:818-988-0771
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist