Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 053462-1 | NY |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS038427 | PA |
NPI | 1114241452 |
---|---|
Provider Name | Dr. Saman Souri |
First Address | Ft Washington, PA 19034-2714 |
Second Address | Harleysville, PA 19438-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 21/02/2013 |