Provider Demographics
NPI:1942558648
Name:SHENASI, SAMIRA (DDS)
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:SHENASI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14213 RIVER STORY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2402
Mailing Address - Country:US
Mailing Address - Phone:703-261-3649
Mailing Address - Fax:
Practice Address - Street 1:7768 OZARK DR STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5891
Practice Address - Country:US
Practice Address - Phone:703-261-3649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001164122300000X
FLDN297651223G0001X
VA0401413748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist