=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083582456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMI HERSEL DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 W BURBANK BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-558-5630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 W BURBANK BLVD
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91506-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-558-5630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR
-----------------------------------------------------
Name | SAMI HERSEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 818-558-5630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------