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NPI Code Detail

MEDICARE: EHAB SAMAAN DDS, INC

MEDICARE: EHAB SAMAAN DDS, INC
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
1122300000XDentist

General Provider Information

NPI Number : 1073236881
Entity Type Code : Organization
Provider Name (Legal Business Name) : EHAB SAMAAN DDS, INC
Provider Business Mailing Address
First Line : 4200 N LAKEWOOD BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90808-1558
Country : US
Telephone Number : 562-420-1701
Fax Number : 562-421-8447
Provider Business Practice Location Address
First Line : 4200 N LAKEWOOD BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90808-1558
Country : US
Telephone Number : 562-420-1701
Fax Number : 562-421-8447
Authorized Official
Title or Position : DDS
Name : MR. EHAB SEDKY SAMAAN
Credential :
Telephone Number : 562-420-1701
Provider Enumeration Date : 09/26/2022
Last Update Date : 12/07/2022

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