Provider Demographics
NPI:1750586590
Name:SAMUEL R MAEHARA DDS INC
Entity type:Organization
Organization Name:SAMUEL R MAEHARA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-865-0013
Mailing Address - Street 1:17700 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4011
Mailing Address - Country:US
Mailing Address - Phone:562-865-0013
Mailing Address - Fax:563-860-7136
Practice Address - Street 1:17700 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4011
Practice Address - Country:US
Practice Address - Phone:562-865-0013
Practice Address - Fax:563-860-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB18371-01OtherMEDI-CAL