Provider Demographics
NPI:1821100264
Name:FAHMY, BAHER SAMIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAHER
Middle Name:SAMIR
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 1:12575 NEWPORT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2452
Mailing Address - Country:US
Mailing Address - Phone:714-731-6100
Mailing Address - Fax:714-731-7494
Practice Address - Street 1:12575 NEWPORT AVE STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2452
Practice Address - Country:US
Practice Address - Phone:714-731-6100
Practice Address - Fax:714-731-7494
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice