Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 40428 | CA |
NPI | 1114028222 |
---|---|
Provider Name | Dr. Samer Magdi Ebeid |
First Address | San Rafael, CA 94903-3431 |
Second Address | San Rafael, CA 94903-3431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |