Healthcare Provider Details

I. General information

NPI: 1437463882
Provider Name (Legal Business Name): SAMUEL SAESIM D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 11/02/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 E 17TH ST STE A
SANTA ANA CA
92705-8603
US

IV. Provider business mailing address

1971 E 17TH ST STE A
SANTA ANA CA
92705-8603
US

V. Phone/Fax

Practice location:
  • Phone: 714-486-1275
  • Fax:
Mailing address:
  • Phone: 805-390-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3355
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: