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General NPI Number Information
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NPI Number | 1225137888
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Entity Type | Individual
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Provider Name | SAMAR KOOPAH DDS
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 166 GEARY ST # 8
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-5602
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Country | US
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Telephone | 415-260-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 3957 RANCHO RD
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City | LAFAYETTE
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State | CA
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Zip | 94549-2821
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Country | US
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Telephone | 925-284-5075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 52879
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License Number State | CA
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