Healthcare Provider Details

I. General information

NPI: 1093544553
Provider Name (Legal Business Name): SAMEER QURESHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W MANCHESTER AVE
LOS ANGELES CA
90044-5718
US

IV. Provider business mailing address

731 N EUCLID ST
FULLERTON CA
92832-1007
US

V. Phone/Fax

Practice location:
  • Phone: 323-753-1411
  • Fax:
Mailing address:
  • Phone: 657-631-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number110401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: