Provider Demographics
NPI:1467708313
Name:DAVIS, SAMIRA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:TOLOUIE (MAIDEN LAST NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 KIRKLAND WAY
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-822-3505
Mailing Address - Fax:
Practice Address - Street 1:523 KIRKLAND WAY
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-822-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARR60294821390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program