Provider Demographics
NPI:1639389919
Name:OURSHANO, SAMI
Entity Type:Individual
Prefix:DR
First Name:SAMI
Middle Name:
Last Name:OURSHANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14526 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4176
Mailing Address - Country:US
Mailing Address - Phone:818-893-7858
Mailing Address - Fax:818-893-6803
Practice Address - Street 1:14526 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4176
Practice Address - Country:US
Practice Address - Phone:818-893-7858
Practice Address - Fax:818-893-6803
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice