Provider Demographics
NPI:1750538062
Name:FARAGALLA, AMGAD A (DDS)
Entity type:Individual
Prefix:DR
First Name:AMGAD
Middle Name:A
Last Name:FARAGALLA
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 1:659 S CENTRAL VALLEY HWY
Mailing Address - Street 2:PO BOX 1060
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:655 S CENTRAL VALLEY HWY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2790
Practice Address - Country:US
Practice Address - Phone:661-746-9194
Practice Address - Fax:661-746-9197
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice