Provider Demographics
NPI:1376743583
Name:PURI, SAMEER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:
Last Name:PURI
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 1:18399 VENTURA BLVD
Mailing Address - Street 2:#251
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4233
Mailing Address - Country:US
Mailing Address - Phone:818-345-5286
Mailing Address - Fax:818-975-5083
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:#251
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4233
Practice Address - Country:US
Practice Address - Phone:818-345-5286
Practice Address - Fax:818-975-5083
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist