Provider Demographics
NPI:1023170107
Name:ALFAKIANI, KAMAL (DDS)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:ALFAKIANI
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 1:236 W CALLE MONTE VIS
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2200
Mailing Address - Country:US
Mailing Address - Phone:716-316-6630
Mailing Address - Fax:
Practice Address - Street 1:3170 N ARIZONA AVE
Practice Address - Street 2:STE1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7164
Practice Address - Country:US
Practice Address - Phone:480-558-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67791223X0400X
WADE000103741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics