Provider Demographics
NPI:1730197641
Name:JOUDEH, SAMER ATALLAH III (DMD PA)
Entity type:Individual
Prefix:
First Name:SAMER
Middle Name:ATALLAH
Last Name:JOUDEH
Suffix:III
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FLEETWOOD DR
Mailing Address - Street 2:STE D
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640
Mailing Address - Country:US
Mailing Address - Phone:864-855-0383
Mailing Address - Fax:864-855-0390
Practice Address - Street 1:109 FLEETWOOD DR
Practice Address - Street 2:STE D
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640
Practice Address - Country:US
Practice Address - Phone:864-855-0383
Practice Address - Fax:864-855-0390
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG1698Medicaid
12739Medicare UPIN