Healthcare Provider Details

I. General information

NPI: 1275649261
Provider Name (Legal Business Name): JUAN M SAMMAN DDS , MSC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 S END AVE 27J
NEW YORK NY
10280-1005
US

IV. Provider business mailing address

355 S END AVE 27J
NEW YORK NY
10280-1005
US

V. Phone/Fax

Practice location:
  • Phone: 212-321-2423
  • Fax: 212-321-1506
Mailing address:
  • Phone: 212-321-2423
  • Fax: 212-321-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number040685
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: