Provider Demographics
NPI:1679784508
Name:MEGALLY, AHMED R (DDS)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:R
Last Name:MEGALLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W OLIVE AVE
Mailing Address - Street 2:SUITE # 115
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2433
Mailing Address - Country:US
Mailing Address - Phone:209-722-9411
Mailing Address - Fax:209-722-7437
Practice Address - Street 1:645 W OLIVE AVE
Practice Address - Street 2:SUITE # 115
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2433
Practice Address - Country:US
Practice Address - Phone:209-722-9411
Practice Address - Fax:209-722-7437
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1686641OtherUNITED CONCORDIA PROVIDER
CAG94075-01Medicaid
CAG98644-01OtherHEALTHY FAMILIES PROVIDER