Provider Demographics
NPI:1477160331
Name:MOSOOF, SAMER
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:
Last Name:MOSOOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MONROE CT
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1365
Mailing Address - Country:US
Mailing Address - Phone:224-226-7888
Mailing Address - Fax:
Practice Address - Street 1:9 MONROE CT
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1365
Practice Address - Country:US
Practice Address - Phone:224-226-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019032923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist