Provider Demographics
NPI:1275621831
Name:ALSAMAAN, TARIQ HAFEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:HAFEZ
Last Name:ALSAMAAN
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:PO BOX 1939
Mailing Address - Street 2:
Mailing Address - City:SANTA YNEZ
Mailing Address - State:CA
Mailing Address - Zip Code:93460-1939
Mailing Address - Country:US
Mailing Address - Phone:805-717-3301
Mailing Address - Fax:909-758-9228
Practice Address - Street 1:8906 SAN BERNARDINO RD
Practice Address - Street 2:SUITE 130
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-8801
Practice Address - Country:US
Practice Address - Phone:909-758-9200
Practice Address - Fax:909-758-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice