Provider Demographics
NPI:1316564503
Name:RASEKH, SAMANTHA EMMA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:EMMA
Last Name:RASEKH
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 1:8320 COLESVILLE RD APT 103
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6364
Mailing Address - Country:US
Mailing Address - Phone:206-354-7254
Mailing Address - Fax:
Practice Address - Street 1:7122 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-7741
Practice Address - Country:US
Practice Address - Phone:410-444-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16976122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty