Provider Demographics
NPI:1194108191
Name:NAMOO, SAMER (DDS)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:
Last Name:NAMOO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SAMIR
Other - Middle Name:
Other - Last Name:NAMOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10821 VIA TIMOTEO
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1231
Mailing Address - Country:US
Mailing Address - Phone:619-277-3903
Mailing Address - Fax:619-295-2385
Practice Address - Street 1:10821 VIA TIMOTEO
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1231
Practice Address - Country:US
Practice Address - Phone:619-277-3903
Practice Address - Fax:619-295-2385
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64546122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist