Healthcare Provider Details

I. General information

NPI: 1154257194
Provider Name (Legal Business Name): MAKARIOUS SAMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 N MOUNT JULIET RD
MOUNT JULIET TN
37122-3049
US

IV. Provider business mailing address

6405 WILDGROVE DR
ANTIOCH TN
37013-5668
US

V. Phone/Fax

Practice location:
  • Phone: 615-241-8023
  • Fax:
Mailing address:
  • Phone: 615-674-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13220
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: