Provider Demographics
NPI:1588006902
Name:FARAJ, SAMER ADNAN (BDS)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:ADNAN
Last Name:FARAJ
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE STREET D 432
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-1156
Mailing Address - Country:US
Mailing Address - Phone:925-577-6309
Mailing Address - Fax:
Practice Address - Street 1:6540 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3651
Practice Address - Country:US
Practice Address - Phone:330-758-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0246231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155587Medicaid