MEDICARE: MAKARIOUS SAMAN

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	13220	TN

General Provider Information

NPI Number	:	1154257194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKARIOUS SAMAN

Provider Business Mailing Address
First Line	:	6405 WILDGROVE DR
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-5668
Country	:	US
Telephone Number	:	615-674-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	4155 N MOUNT JULIET RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-3049
Country	:	US
Telephone Number	:	615-241-8023
Fax Number	:

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

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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