Provider Demographics
NPI:1225137888
Name:KOOPAH, SAMAR (DDS)
Entity Type:Individual
Prefix:
First Name:SAMAR
Middle Name:
Last Name:KOOPAH
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 1:3957 RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2821
Mailing Address - Country:US
Mailing Address - Phone:925-284-5075
Mailing Address - Fax:
Practice Address - Street 1:166 GEARY ST
Practice Address - Street 2:# 8
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5602
Practice Address - Country:US
Practice Address - Phone:415-260-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice