Provider Demographics
NPI:1184816738
Name:NAMDARIAN, SAM S (DMD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:S
Last Name:NAMDARIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 N FRESNO ST
Mailing Address - Street 2:STE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-431-1772
Mailing Address - Fax:559-431-0506
Practice Address - Street 1:7770 N FRESNO ST
Practice Address - Street 2:STE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2412
Practice Address - Country:US
Practice Address - Phone:559-431-1772
Practice Address - Fax:559-431-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA557291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55729OtherDEA- FN0422270