Provider Demographics
NPI:1568539856
Name:GENDY, SAMEH WAHIB (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMEH
Middle Name:WAHIB
Last Name:GENDY
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 1:12241 ARROWHEAD ST
Mailing Address - Street 2:#18
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3875
Mailing Address - Country:US
Mailing Address - Phone:714-423-5476
Mailing Address - Fax:
Practice Address - Street 1:1696 W KATELLA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3015
Practice Address - Country:US
Practice Address - Phone:714-635-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice