Provider Demographics
NPI:1730258245
Name:MIKHAIL, SAMAR FAHIM (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:FAHIM
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SAMAR
Other - Middle Name:FAHIM
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:15388 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2190
Mailing Address - Country:US
Mailing Address - Phone:949-878-7219
Mailing Address - Fax:
Practice Address - Street 1:285 W WESTERN AVE STE 102
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440-1230
Practice Address - Country:US
Practice Address - Phone:231-930-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34091122300000X
CA52385122300000X
MI2901601624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist