Provider Demographics
NPI:1801588934
Name:AL-ISMAEEL, SAMER (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:
Last Name:AL-ISMAEEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13867 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3039
Mailing Address - Country:US
Mailing Address - Phone:313-720-5371
Mailing Address - Fax:
Practice Address - Street 1:14024 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1268
Practice Address - Country:US
Practice Address - Phone:734-720-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist