Provider Demographics
NPI:1548230972
Name:GHARIB, SAMAN REZA (DMD)
Entity Type:Individual
Prefix:
First Name:SAMAN
Middle Name:REZA
Last Name:GHARIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 TOWER DR UNIT 226
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5827
Mailing Address - Country:US
Mailing Address - Phone:847-832-4681
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HEALTH CLINIC
Practice Address - Street 2:3001A 6TH ST
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist