Provider Demographics
NPI:1972059103
Name:ALRAJAB, SAMIR (DMD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:ALRAJAB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 DOMAIN BLVD
Mailing Address - Street 2:UNIT #3344
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:832-860-4052
Mailing Address - Fax:
Practice Address - Street 1:500 CANYON RIDGE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1632
Practice Address - Country:US
Practice Address - Phone:512-837-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist