Provider Demographics
NPI:1093444317
Name:SAMATAR, AMAL
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:SAMATAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18330 NE 99TH WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6902
Mailing Address - Country:US
Mailing Address - Phone:707-479-4818
Mailing Address - Fax:
Practice Address - Street 1:2235 148TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3726
Practice Address - Country:US
Practice Address - Phone:425-458-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61320745122300000X
390200000X
WADE61320745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program