Provider Demographics
NPI:1538957360
Name:SAMUEL J NASSAB DMD PLLC
Entity type:Organization
Organization Name:SAMUEL J NASSAB DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NASSAB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-201-2621
Mailing Address - Street 1:100 GOODMAN CIR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2860
Mailing Address - Country:US
Mailing Address - Phone:704-786-9100
Mailing Address - Fax:
Practice Address - Street 1:100 GOODMAN CIR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2860
Practice Address - Country:US
Practice Address - Phone:704-786-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty