Provider Demographics
NPI:1114646338
Name:SAMADI, EILKAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EILKAY
Middle Name:
Last Name:SAMADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35751 GATEWAY DR UNIT C333
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6036
Mailing Address - Country:US
Mailing Address - Phone:760-845-7624
Mailing Address - Fax:
Practice Address - Street 1:42505 WASHINGTON ST STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8835
Practice Address - Country:US
Practice Address - Phone:760-342-4341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist