Provider Demographics
NPI:1609965276
Name:BSOUL, SAMER A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:A
Last Name:BSOUL
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 MAINLAND DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3748
Mailing Address - Country:US
Mailing Address - Phone:210-523-2700
Mailing Address - Fax:210-523-2701
Practice Address - Street 1:8111 MAINLAND DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3748
Practice Address - Country:US
Practice Address - Phone:210-523-2700
Practice Address - Fax:210-523-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180497302Medicaid
TX180497304Medicaid
TX180497303Medicaid