Provider Demographics
NPI:1629312947
Name:DR.SAMAAN DENTAL GROUP
Entity Type:Organization
Organization Name:DR.SAMAAN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMAAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-531-7373
Mailing Address - Street 1:5203 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2438
Mailing Address - Country:US
Mailing Address - Phone:562-531-7373
Mailing Address - Fax:562-531-0489
Practice Address - Street 1:5203 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2438
Practice Address - Country:US
Practice Address - Phone:562-531-7373
Practice Address - Fax:562-531-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty