Provider Demographics
NPI:1699786152
Name:BANOUB, SAMI K (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMI
Middle Name:K
Last Name:BANOUB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 STIRLING CENTER PL
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4889
Mailing Address - Country:US
Mailing Address - Phone:407-915-5421
Mailing Address - Fax:
Practice Address - Street 1:752 STIRLING CENTER PL
Practice Address - Street 2:SUITE 1000
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4889
Practice Address - Country:US
Practice Address - Phone:407-915-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice