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General NPI Number Information
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NPI Number | 1972653244
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Entity Type | Individual
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Provider Name | SAMAR MOKHAYESH DDS
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30060 23 MILE RD
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5718
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Country | US
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Telephone | 586-949-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 52833 SEVEN OAKS DR
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-2992
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Country | US
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Telephone |
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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 | 28901017682
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License Number State | MI
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