Healthcare Provider Details

I. General information

NPI: 1801916986
Provider Name (Legal Business Name): ELAHEH SAMSANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 PEBBLE BEACH DR STE 104
CITRUS HEIGHTS CA
95610-7790
US

IV. Provider business mailing address

7916 PEBBLE BEACH DR STE 104
CITRUS HEIGHTS CA
95610-7790
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-0545
  • Fax: 916-962-0927
Mailing address:
  • Phone: 916-962-0545
  • Fax: 916-962-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number47415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: