Provider Demographics
NPI:1780910745
Name:BENACHENHOU, SAMIR ABDERRAHMANE (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:ABDERRAHMANE
Last Name:BENACHENHOU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ABDERRAHMANE
Other - Middle Name:SAMIR
Other - Last Name:BENACHENHOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:101 BAUGHMANS LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4894
Mailing Address - Country:US
Mailing Address - Phone:301-662-0554
Mailing Address - Fax:301-662-0587
Practice Address - Street 1:101 BAUGHMANS LN
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4894
Practice Address - Country:US
Practice Address - Phone:301-662-0554
Practice Address - Fax:301-662-0587
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice