Provider Demographics
NPI:1578146908
Name:DAHSHAN, SAMANTHA M (DMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:DAHSHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E 8TH ST BLDG APT 2511
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2165
Mailing Address - Country:US
Mailing Address - Phone:708-465-0004
Mailing Address - Fax:
Practice Address - Street 1:2 E 8TH ST BLDG APT 2511
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2165
Practice Address - Country:US
Practice Address - Phone:708-465-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031853122300000X
MADN1859084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist