Provider Demographics
NPI:1790926608
Name:FAHMY, EMAD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:S
Last Name:FAHMY
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 1:18758 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4169
Mailing Address - Country:US
Mailing Address - Phone:626-912-5599
Mailing Address - Fax:626-912-6180
Practice Address - Street 1:18758 AMAR RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4169
Practice Address - Country:US
Practice Address - Phone:626-912-5599
Practice Address - Fax:626-912-6180
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist