Healthcare Provider Details

I. General information

NPI: 1851948327
Provider Name (Legal Business Name): AL-SAMARRAI DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28212 KELLY JOHNSON PKWY STE 220
VALENCIA CA
91355-5090
US

IV. Provider business mailing address

28212 KELLY JOHNSON PKWY STE 220
VALENCIA CA
91355-5090
US

V. Phone/Fax

Practice location:
  • Phone: 661-775-8822
  • Fax: 661-775-8311
Mailing address:
  • Phone: 661-775-8822
  • Fax: 661-775-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. HAKAM AL-SAMARRAI
Title or Position: PRESIDENT
Credential: DMD
Phone: 661-775-8822