Provider Demographics
NPI:1417025677
Name:AMANFU, EMMANUEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:A
Last Name:AMANFU
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 1:10450 EASTBORNE AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-6170
Mailing Address - Country:US
Mailing Address - Phone:310-470-1536
Mailing Address - Fax:
Practice Address - Street 1:9755 ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3677
Practice Address - Country:US
Practice Address - Phone:562-925-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice