Provider Demographics
NPI:1639487812
Name:ALBADAWI, SAMER (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:ALBADAWI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GIBSON DR
Mailing Address - Street 2:823
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5400
Mailing Address - Country:US
Mailing Address - Phone:661-496-1470
Mailing Address - Fax:
Practice Address - Street 1:1737 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2104
Practice Address - Country:US
Practice Address - Phone:916-482-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA602421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program