Provider Demographics
NPI:1831151471
Name:AMIRANI, SAM S (DDS)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:AMIRANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1431 BLUFFVIEW ST
Mailing Address - Street 2:STE 212
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3039
Mailing Address - Country:US
Mailing Address - Phone:316-686-7155
Mailing Address - Fax:316-686-4209
Practice Address - Street 1:1431 BLUFFVIEW ST
Practice Address - Street 2:STE 212
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3039
Practice Address - Country:US
Practice Address - Phone:316-686-7155
Practice Address - Fax:316-686-4209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS70631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116700OtherBLUE CROSS BLUE SHIELD ID