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General NPI Number Information
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NPI Number | 1144610247
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Entity Type | Organization
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Legal Business Name | SAMUEL DEMIRDJI, DDS, MS, INC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 7199 BOULDER AVE SUITE 5
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City | HIGHLAND
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State | CA
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Zip | 92346-3398
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Country | US
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Telephone | 909-864-6510
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Fax | 909-864-7410
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Provider Business Mailing Address
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Address Line | 7199 BOULDER AVE SUITE 5
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City | HIGHLAND
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State | CA
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Zip | 92346-3398
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Country | US
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Telephone | 909-864-6510
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Fax | 909-864-7410
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL DEMIRDJI
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Credential | D.D.S. , M.S.
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Telephone | 909-864-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 48447
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License Number State | CA
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