Provider Demographics
NPI:1336115351
Name:HISHMEH, SAMIR B (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:B
Last Name:HISHMEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:301-384-5700
Mailing Address - Fax:301-384-5619
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-384-5700
Practice Address - Fax:301-384-5619
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD503819Medicare UPIN