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General NPI Number Information
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NPI Number | 1578146908
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Entity Type | Individual
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Provider Name | SAMANTHA M DAHSHAN DMD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 2 E 8TH ST BLDG APT 2511
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City | CHICAGO
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State | IL
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Zip | 60605-2165
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Country | US
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Telephone | 708-465-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 2 E 8TH ST BLDG APT 2511
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City | CHICAGO
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State | IL
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Zip | 60605-2165
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Country | US
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Telephone | 708-465-0004
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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 | 019.031853
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1859084
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License Number State | MA
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