MEDICARE: GEORGE SAMY MESSIAH DDS

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	DDS105355	CA

General Provider Information

NPI Number	:	1902405731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE SAMY MESSIAH DDS

Provider Business Mailing Address
First Line	:	1232 AMARYLLIS WAY
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-7327
Country	:	US
Telephone Number	:	951-824-0699
Fax Number	:

Provider Business Practice Location Address
First Line	:	12571 LIMONITE AVE
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	91752-3676
Country	:	US
Telephone Number	:	951-360-3444
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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