Provider Demographics
NPI:1629226576
Name:TAWFIK, HAYSAM GALAL (DMD)
Entity type:Individual
Prefix:DR
First Name:HAYSAM
Middle Name:GALAL
Last Name:TAWFIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 NC HIGHWAY 42 W STE 214
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7998
Mailing Address - Country:US
Mailing Address - Phone:919-661-6161
Mailing Address - Fax:
Practice Address - Street 1:5638 NC HIGHWAY 42 W STE 214
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-661-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90111223G0001X
FLDN18161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist