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General NPI Number Information
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NPI Number | 1245104827
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Entity Type | Individual
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Provider Name | MESK SAMARA
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Gender | Female
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 12880 CENTRAL AVE
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City | BOULDER CREEK
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State | CA
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Zip | 95006-9114
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Country | US
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Telephone | 831-338-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 16370 MATILIJA DR
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City | LOS GATOS
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State | CA
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Zip | 95030-3079
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Country | US
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Telephone | 708-835-1968
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 112426
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License Number State | CA
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