Healthcare Provider Details

I. General information

NPI: 1629048160
Provider Name (Legal Business Name): SAMIRA MEYMAND DDS/MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11571 SAN JOSE BLVD UNIT 1
JACKSONVILLE FL
32223-7257
US

IV. Provider business mailing address

11571 SAN JOSE BLVD UNIT 1
JACKSONVILLE FL
32223-7257
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-2667
  • Fax:
Mailing address:
  • Phone: 214-394-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN18532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: