Provider Demographics
NPI:1346073079
Name:DORRI, SAMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMIN
Middle Name:
Last Name:DORRI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 CLUBLAND TRL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4019
Mailing Address - Country:US
Mailing Address - Phone:404-901-0116
Mailing Address - Fax:
Practice Address - Street 1:1950 SPECTRUM CIR SE STE 545
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8501
Practice Address - Country:US
Practice Address - Phone:770-952-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1235661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice