Provider Demographics
NPI:1346395670
Name:EL-SAMRA, AHMED H (DMD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:H
Last Name:EL-SAMRA
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 1:312 MASS AVE
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1219
Mailing Address - Country:US
Mailing Address - Phone:978-582-0800
Mailing Address - Fax:978-582-6400
Practice Address - Street 1:312 MASS AVE
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1219
Practice Address - Country:US
Practice Address - Phone:978-582-0800
Practice Address - Fax:978-582-6400
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1432772OtherUNITED CONCORDIA ID
MA9745939Medicaid
MA922OtherDELTA OF MA-GROUP#
MAX10633OtherBCBS PRACTICE ID
MA0201316Medicaid