Provider Demographics
NPI:1467891630
Name:HARAKE, SAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:
Last Name:HARAKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMAR
Other - Middle Name:
Other - Last Name:FARAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5970 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3625
Mailing Address - Country:US
Mailing Address - Phone:313-903-0847
Mailing Address - Fax:
Practice Address - Street 1:5970 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3625
Practice Address - Country:US
Practice Address - Phone:313-903-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist