Provider Demographics
NPI:1073684635
Name:SAMAAN, SAMY
Entity Type:Individual
Prefix:DR
First Name:SAMY
Middle Name:
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8275 SENTINAE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4459
Mailing Address - Country:US
Mailing Address - Phone:815-302-1661
Mailing Address - Fax:
Practice Address - Street 1:8275 SENTINAE CHASE DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4459
Practice Address - Country:US
Practice Address - Phone:815-302-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0262231223G0001X
GADN014564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice