Provider Demographics
NPI:1619259934
Name:MOMIN, SAMIR K (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:K
Last Name:MOMIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 MCNEIL DR APT 513
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-6908
Mailing Address - Country:US
Mailing Address - Phone:512-740-1435
Mailing Address - Fax:
Practice Address - Street 1:1000 E 41ST STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751
Practice Address - Country:US
Practice Address - Phone:512-458-3600
Practice Address - Fax:512-458-3033
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist