Provider Demographics
NPI:1336642677
Name:HAFEZ AND GHONEIM DENTAL CORP
Entity Type:Organization
Organization Name:HAFEZ AND GHONEIM DENTAL CORP
Other - Org Name:TOOTH BERRY KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:HAFEZ
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-753-9359
Mailing Address - Street 1:1009 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5305
Mailing Address - Country:US
Mailing Address - Phone:916-753-9359
Mailing Address - Fax:
Practice Address - Street 1:4850 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4111
Practice Address - Country:US
Practice Address - Phone:916-926-0001
Practice Address - Fax:916-926-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty