Provider Demographics
NPI:1396154746
Name:IMAM, YEHIA (DDS)
Entity type:Individual
Prefix:DR
First Name:YEHIA
Middle Name:
Last Name:IMAM
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 1:4939 W RAY RD # 4-321
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2065
Mailing Address - Country:US
Mailing Address - Phone:480-241-8017
Mailing Address - Fax:480-907-5899
Practice Address - Street 1:2034 E SOUTHERN AVE STE A
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7522
Practice Address - Country:US
Practice Address - Phone:480-775-8056
Practice Address - Fax:480-775-8064
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD32551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice