Healthcare Provider Details

I. General information

NPI: 1548358740
Provider Name (Legal Business Name): SAMIR BATNIJI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S GRAND AVE SUITE D
DIAMOND BAR CA
91765
US

IV. Provider business mailing address

1111 S GRAND AVE SUITE D
DIAMOND BAR CA
91765
US

V. Phone/Fax

Practice location:
  • Phone: 909-396-9944
  • Fax: 909-396-9984
Mailing address:
  • Phone: 909-396-9944
  • Fax: 909-396-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number37081
License Number StateCA

VIII. Authorized Official

Name: DR. SAMIR BATNIJI
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-396-9944