Provider Demographics
NPI:1134788706
Name:SAMRA, NADA (DMD)
Entity type:Individual
Prefix:DR
First Name:NADA
Middle Name:
Last Name:SAMRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:NADA
Other - Middle Name:
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 RIVER PL APT 1516
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4371
Mailing Address - Country:US
Mailing Address - Phone:917-399-4447
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER PL APT 1516
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4371
Practice Address - Country:US
Practice Address - Phone:917-399-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice