Provider Demographics
NPI:1093226177
Name:JAIN, SAMEER DILIP (DDS, MS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:DILIP
Last Name:JAIN
Suffix:
Gender:M
Credentials:DDS, MS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NORTH 12TH STREET
Mailing Address - Street 2:BOX #980566
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298
Mailing Address - Country:US
Mailing Address - Phone:804-828-6288
Mailing Address - Fax:
Practice Address - Street 1:6325 TOPANGA CANYON BLVD STE 235
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2024
Practice Address - Country:US
Practice Address - Phone:818-992-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158511223E0200X
NVS7-111C1223E0200X
CA1062071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics