Healthcare Provider Details

I. General information

NPI: 1205531530
Provider Name (Legal Business Name): SAMI HASAN ALMAYYAHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 MESA RIDGE PKWY STE 200
FOUNTAIN CO
80817-1563
US

IV. Provider business mailing address

508 MCINTOSH DR
SHREVEPORT LA
71115-3059
US

V. Phone/Fax

Practice location:
  • Phone: 719-624-0177
  • Fax:
Mailing address:
  • Phone: 214-828-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00206576
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: