Provider Demographics
NPI:1407928716
Name:DAFTARIAN, SAMANEH MARYAM (DDS)
Entity Type:Individual
Prefix:MS
First Name:SAMANEH
Middle Name:MARYAM
Last Name:DAFTARIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10750 BARKER CYPRESS RD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:281-213-8666
Mailing Address - Fax:281-256-2819
Practice Address - Street 1:10750 BARKER CYPRESS RD
Practice Address - Street 2:SUITE #111
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:281-213-8666
Practice Address - Fax:281-256-2819
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice