Healthcare Provider Details

I. General information

NPI: 1801654884
Provider Name (Legal Business Name): SAMI A SAHLOUL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 TRENTON RD STE 101
CLARKSVILLE TN
37040-2358
US

IV. Provider business mailing address

2298 TRENTON RD STE 101
CLARKSVILLE TN
37040-2358
US

V. Phone/Fax

Practice location:
  • Phone: 978-489-8940
  • Fax:
Mailing address:
  • Phone: 978-489-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12904
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: