Provider Demographics
NPI:1407272925
Name:BATNIJI, SAMIR (DDS)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:BATNIJI
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 1:1111 GRAND AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4171
Mailing Address - Country:US
Mailing Address - Phone:909-396-9944
Mailing Address - Fax:909-396-9984
Practice Address - Street 1:1111 GRAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4171
Practice Address - Country:US
Practice Address - Phone:909-396-9944
Practice Address - Fax:909-396-9984
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics