Provider Demographics
NPI:1336578731
Name:JAFARI, SAMIRA
Entity type:Individual
Prefix:DR
First Name:SAMIRA
Middle Name:
Last Name:JAFARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 UPPER HEMBREE RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0914
Mailing Address - Country:US
Mailing Address - Phone:470-508-0090
Mailing Address - Fax:
Practice Address - Street 1:1240 UPPER HEMBREE RD STE C
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0914
Practice Address - Country:US
Practice Address - Phone:470-508-0090
Practice Address - Fax:470-508-0099
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice