Provider Demographics
NPI:1790479780
Name:YASEEN, SAMAR
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:
Last Name:YASEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2785
Mailing Address - Country:US
Mailing Address - Phone:832-228-0357
Mailing Address - Fax:
Practice Address - Street 1:56 OAKLAND RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2785
Practice Address - Country:US
Practice Address - Phone:832-228-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02974900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist