Provider Demographics
NPI:1033351085
Name:MUMTAZ, SAMERA (BDS,DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMERA
Middle Name:
Last Name:MUMTAZ
Suffix:
Gender:F
Credentials:BDS,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2431
Mailing Address - Country:US
Mailing Address - Phone:610-352-4767
Mailing Address - Fax:610-352-1364
Practice Address - Street 1:6780 MARKET ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2431
Practice Address - Country:US
Practice Address - Phone:610-352-4767
Practice Address - Fax:610-352-1364
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist