MEDICARE: DR. SAMERA MUMTAZ BDS,DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS037769	PA

General Provider Information

NPI Number	:	1033351085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMERA MUMTAZ BDS,DMD

Provider Business Mailing Address
First Line	:	6780 MARKET ST
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2431
Country	:	US
Telephone Number	:	610-352-4767
Fax Number	:	610-352-1364

Provider Business Practice Location Address
First Line	:	6780 MARKET ST
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2431
Country	:	US
Telephone Number	:	610-352-4767
Fax Number	:	610-352-1364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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