Provider Demographics
NPI:1104967223
Name:SAMIR B HALAKA DDS, INC
Entity type:Organization
Organization Name:SAMIR B HALAKA DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:BARSOUME
Authorized Official - Last Name:HALAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-469-8816
Mailing Address - Street 1:6767 W SUNSET BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7177
Mailing Address - Country:US
Mailing Address - Phone:323-469-8816
Mailing Address - Fax:323-469-2679
Practice Address - Street 1:6767 W SUNSET BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7177
Practice Address - Country:US
Practice Address - Phone:323-469-8816
Practice Address - Fax:323-469-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABY37115261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37115-01OtherMEDICAL