Provider Demographics
NPI:1225131840
Name:HANNA, SAMIA SHALABY (DMD)
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:SHALABY
Last Name:HANNA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7152 LEIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3988
Mailing Address - Country:US
Mailing Address - Phone:580-678-8183
Mailing Address - Fax:714-993-3754
Practice Address - Street 1:2641 HAMNER AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3637
Practice Address - Country:US
Practice Address - Phone:951-739-7770
Practice Address - Fax:951-739-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55831223G0001X
CA63163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225131840OtherDENTI-CAL
OK100026220BMedicaid