Provider Demographics
NPI:1821202086
Name:HERSEL, SAMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMI
Middle Name:
Last Name:HERSEL
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 1:1639 CAMDEN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7517
Mailing Address - Country:US
Mailing Address - Phone:310-903-3283
Mailing Address - Fax:
Practice Address - Street 1:1510 W VERDUGO AVE STE F
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2473
Practice Address - Country:US
Practice Address - Phone:818-558-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA519361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice