Provider Demographics
NPI:1720344823
Name:TOLOUE, SAMIRA M (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SAMIRA
Middle Name:M
Last Name:TOLOUE
Suffix:
Gender:F
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 1:209 DENALI PASS
Mailing Address - Street 2:STE A
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7499
Mailing Address - Country:US
Mailing Address - Phone:512-528-1400
Mailing Address - Fax:
Practice Address - Street 1:209 DENALI PASS
Practice Address - Street 2:STE A
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7499
Practice Address - Country:US
Practice Address - Phone:512-528-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics