MEDICARE: DR. SAMAN SOURI D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	053462-1	NY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS038427	PA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	16083	MD

General Provider Information

NPI Number	:	1114241452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMAN SOURI D.M.D

Provider Business Mailing Address
First Line	:	300 HOSPITAL DR STE 237
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5856
Country	:	US
Telephone Number	:	410-761-4684
Fax Number	:	410-888-7086

Provider Business Practice Location Address
First Line	:	300 HOSPITAL DR STE 237
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-5856
Country	:	US
Telephone Number	:	410-761-4684
Fax Number	:	410-888-7086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	02/23/2026

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