Provider Demographics
NPI:1073719860
Name:ATTIA, SAMIH ABDELMALAK (DMD)
Entity Type:Individual
Prefix:
First Name:SAMIH
Middle Name:ABDELMALAK
Last Name:ATTIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 79TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-790-0370
Mailing Address - Fax:718-417-1305
Practice Address - Street 1:589 KNICKERBOCKER AVE
Practice Address - Street 2:ALEXANDER MILLER DDS PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221
Practice Address - Country:US
Practice Address - Phone:718-366-9191
Practice Address - Fax:718-417-1305
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0469321122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02390861Medicaid