Provider Demographics
NPI:1588912067
Name:SAMRA, LIRON (DDS)
Entity type:Individual
Prefix:DR
First Name:LIRON
Middle Name:
Last Name:SAMRA
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 1:810 BROADWAY
Mailing Address - Street 2:APT 8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4800
Mailing Address - Country:US
Mailing Address - Phone:212-354-0906
Mailing Address - Fax:
Practice Address - Street 1:255 W 36TH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7555
Practice Address - Country:US
Practice Address - Phone:212-354-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist