Provider Demographics
NPI:1275976912
Name:ARSANIOUS, SAMEH
Entity Type:Individual
Prefix:
First Name:SAMEH
Middle Name:
Last Name:ARSANIOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 ELM LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3271
Mailing Address - Country:US
Mailing Address - Phone:951-275-4582
Mailing Address - Fax:
Practice Address - Street 1:14438 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-7520
Practice Address - Country:US
Practice Address - Phone:281-568-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322293702Medicaid
TX322293708Medicaid
TX322293703Medicaid
TX322293701Medicaid