Provider Demographics
NPI:1801923800
Name:YEHIA IMAM, DDS PC
Entity type:Organization
Organization Name:YEHIA IMAM, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEHIA
Authorized Official - Middle Name:ALY
Authorized Official - Last Name:IMAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-775-8056
Mailing Address - Street 1:4939 W. RAY RD.
Mailing Address - Street 2:4321
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2065
Mailing Address - Country:US
Mailing Address - Phone:480-775-8056
Mailing Address - Fax:480-775-8064
Practice Address - Street 1:2034 E SOUTHERN AVE
Practice Address - Street 2:SUITE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD32551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty