Healthcare Provider Details

I. General information

NPI: 1124773973
Provider Name (Legal Business Name): SAM KASRAII DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 STIRLING RD
HOLLYWOOD FL
33024-8065
US

IV. Provider business mailing address

9900 STIRLING RD
HOLLYWOOD FL
33024-8065
US

V. Phone/Fax

Practice location:
  • Phone: 240-401-8719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN31856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: