Provider Demographics
NPI:1063641561
Name:OWHADIAN, SAMERA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMERA
Middle Name:
Last Name:OWHADIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONS GATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8310
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:1414 S GRAND AVE
Practice Address - Street 2:SUITE 485
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3076
Practice Address - Country:US
Practice Address - Phone:213-744-1752
Practice Address - Fax:213-744-1753
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24421122300000X
CA62891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist