Provider Demographics
NPI:1902229164
Name:HEJLAWY, SAMER (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:HEJLAWY
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ALAMO DR STE D
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4246
Mailing Address - Country:US
Mailing Address - Phone:415-996-9981
Mailing Address - Fax:
Practice Address - Street 1:301 ALAMO DR STE D
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4246
Practice Address - Country:US
Practice Address - Phone:415-996-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2021501223E0200X
CA652631223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00202150OtherDENTIST LICENSE NUMBER