Healthcare Provider Details

I. General information

NPI: 1598255648
Provider Name (Legal Business Name): SAMUEL SAESIM DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
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: 949-445-0658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL SAESIM
Title or Position: CEO
Credential: DDS
Phone: 805-390-2623