Provider Demographics
NPI:1033462817
Name:OVESON, SAMIRA JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMIRA
Middle Name:JAY
Last Name:OVESON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:AKHAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 521781
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-1781
Mailing Address - Country:US
Mailing Address - Phone:801-828-5315
Mailing Address - Fax:
Practice Address - Street 1:1408 S 1100 E STE A
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2400
Practice Address - Country:US
Practice Address - Phone:801-828-5315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61893122300000X
UT11318168-9921122300000X
TX28689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist