Provider Demographics
NPI:1689853517
Name:SAMUEL, JEENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEENA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 FM 1092 RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5910
Mailing Address - Country:US
Mailing Address - Phone:281-969-8656
Mailing Address - Fax:281-969-7998
Practice Address - Street 1:738 FM 1092 RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5910
Practice Address - Country:US
Practice Address - Phone:281-969-8656
Practice Address - Fax:281-969-7998
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist