Provider Demographics
NPI:1063649580
Name:ABU-SAMN, FALASTIN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:FALASTIN
Middle Name:R
Last Name:ABU-SAMN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1615 OAK SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4732
Mailing Address - Country:US
Mailing Address - Phone:407-417-0847
Mailing Address - Fax:
Practice Address - Street 1:2570 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-5523
Practice Address - Country:US
Practice Address - Phone:386-304-2677
Practice Address - Fax:386-304-1899
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN222791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry