Provider Demographics
NPI:1235343971
Name:TAHOUN, SAMER MOUSTAFA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:MOUSTAFA
Last Name:TAHOUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1239
Mailing Address - Country:US
Mailing Address - Phone:413-543-1202
Mailing Address - Fax:
Practice Address - Street 1:439 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1239
Practice Address - Country:US
Practice Address - Phone:413-543-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203696Medicaid