Provider Demographics
NPI:1356645303
Name:TADROS, SAMEEH G (DDS)
Entity Type:Individual
Prefix:
First Name:SAMEEH
Middle Name:G
Last Name:TADROS
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 1:23030 LAKE FOREST DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1331
Mailing Address - Country:US
Mailing Address - Phone:949-916-0568
Mailing Address - Fax:949-916-5497
Practice Address - Street 1:10987 NW 72ND TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-3667
Practice Address - Country:US
Practice Address - Phone:786-449-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice