Provider Demographics
NPI:1952530479
Name:FAHMY, TAREK MOHAMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:MOHAMED
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 1:916 S 40TH AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3860
Mailing Address - Country:US
Mailing Address - Phone:440-506-1913
Mailing Address - Fax:
Practice Address - Street 1:916 S 40TH AVE APT 24
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3860
Practice Address - Country:US
Practice Address - Phone:440-506-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH60085479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist