Provider Demographics
NPI:1588340756
Name:MANJEE, SAMIR A
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:A
Last Name:MANJEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 QUEENSBURY WAY W
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4743
Mailing Address - Country:US
Mailing Address - Phone:817-240-4878
Mailing Address - Fax:
Practice Address - Street 1:601 N 77 SUNSHINESTRIP # 4
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8845
Practice Address - Country:US
Practice Address - Phone:956-370-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist