Provider Demographics
NPI:1134179443
Name:GILANI, SAM (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:GILANI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N BEDFORD DR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4322
Mailing Address - Country:US
Mailing Address - Phone:310-274-1047
Mailing Address - Fax:310-274-3181
Practice Address - Street 1:416 N BEDFORD DR
Practice Address - Street 2:SUITE 407
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4322
Practice Address - Country:US
Practice Address - Phone:310-274-1047
Practice Address - Fax:310-274-3181
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD323081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery