Healthcare Provider Details

I. General information

NPI: 1548338148
Provider Name (Legal Business Name): MOUHAB SAMMAN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOLMES ST
KANSAS CITY MO
64108
US

IV. Provider business mailing address

2409 NE 112TH ST
KANSAS CITY MO
64155-4501
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-4175
  • Fax:
Mailing address:
  • Phone: 909-379-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2018010412
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: