Healthcare Provider Details

I. General information

NPI: 1770836918
Provider Name (Legal Business Name): SAMAHA SLEEP SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 WALL ST
CONCORD NH
03301-3742
US

IV. Provider business mailing address

13 WALL ST
CONCORD NH
03301-3742
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2042
  • Fax:
Mailing address:
  • Phone: 603-225-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1686
License Number StateNH

VIII. Authorized Official

Name: DR. JON WILLIAM SAMAHA
Title or Position: OWNER
Credential: DMD, MMSC
Phone: 603-225-2042