Provider Demographics
NPI:1659399277
Name:MEGHADRI, SAMUEL (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MEGHADRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1912
Mailing Address - Country:US
Mailing Address - Phone:908-835-0800
Mailing Address - Fax:908-835-8952
Practice Address - Street 1:7 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1912
Practice Address - Country:US
Practice Address - Phone:908-835-0800
Practice Address - Fax:908-835-8952
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI212581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9050809Medicaid