Provider Demographics
NPI:1528314077
Name:SAMAD, SABIHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SABIHA
Middle Name:
Last Name:SAMAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 54TH ST
Mailing Address - Street 2:APT. 14D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4707
Mailing Address - Country:US
Mailing Address - Phone:716-863-3403
Mailing Address - Fax:
Practice Address - Street 1:245 E 54TH ST
Practice Address - Street 2:APT. 14D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4707
Practice Address - Country:US
Practice Address - Phone:716-863-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
056221OtherLICENSE