Samer Abu Ammra
Individual provider Active NPI Dentist · Fargo, ND
NPI 1245075381 · NPPES record last updated Aug 18, 2025
Key facts
- NPI
- 1245075381
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2516 (ND)
- Practice address
- 4302 13TH Ave S Ste 10
Fargo, ND 58103-3395 - Phone
- (708) 580-9733
- NPI assigned
- Jun 29, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.035698 | IL | MD | Dentist |
| 30.027548 | OH | MD | Dentist |
| 2516 | ND | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30.027548 | OH | |
| Dentist | 122300000X | 019.035698 | IL | |
| Dentist | 122300000X | 2516 | ND | Yes |
Addresses
Primary practice location
4302 13TH Ave S Ste 10
Fargo, ND 58103-3395
Mailing address
4302 13TH Ave S Ste 10
Fargo, ND 58103-3395
Phone (708) 580-9733
Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.