Provider Demographics
NPI:1497187793
Name:SAMEEH G TADROS DDS INC
Entity Type:Organization
Organization Name:SAMEEH G TADROS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEEH
Authorized Official - Middle Name:G
Authorized Official - Last Name:TADROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-916-0568
Mailing Address - Street 1:23030 LAKE FOREST DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1331
Mailing Address - Country:US
Mailing Address - Phone:949-916-0568
Mailing Address - Fax:949-916-5497
Practice Address - Street 1:127 PATHWAY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8846
Practice Address - Country:US
Practice Address - Phone:949-916-0568
Practice Address - Fax:949-916-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty