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General NPI Number Information
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NPI Number | 1598306342
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Entity Type | Individual
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Provider Name | SAMIA HASSOUNEH DMD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 142 SW 2ND ST
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City | CORVALLIS
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State | OR
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Zip | 97333-4716
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Country | US
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Telephone | 541-360-7004
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Fax | 541-516-4055
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Provider Business Mailing Address
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Address Line | PO BOX 11470
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City | EUGENE
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State | OR
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Zip | 97440-3670
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Country | US
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Telephone | 541-360-7004
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Fax | 541-516-4055
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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 | D11160
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License Number State | OR
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