Provider Demographics
NPI:1376151860
Name:GHANEM, SAIF (DDS)
Entity Type:Individual
Prefix:
First Name:SAIF
Middle Name:
Last Name:GHANEM
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 1:18416 N CAVE CREEK RD APT 2052
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-8029
Mailing Address - Country:US
Mailing Address - Phone:734-272-6369
Mailing Address - Fax:
Practice Address - Street 1:9242 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2502
Practice Address - Country:US
Practice Address - Phone:602-943-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0107491223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health