Samer S. Gazale, DDS
Individual provider Active NPI General Practice Dentistry · Juffair, CA
NPI 1609485341 · NPPES record last updated Feb 16, 2024
Key facts
- NPI
- 1609485341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12494841-9921 (UT)
- Practice address
- Nsa 1 Bahrain
Juffair, CA 09834 - Phone
- (619) 490-7163
- NPI assigned
- Jul 29, 2020
- 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)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12494841-9921 | UT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 105078 | CA | |
| General Practice Dentistry | 1223G0001X | 12494841-9921 | UT | Yes |
Addresses
Primary practice location
Nsa 1 Bahrain
Juffair, CA 09834
Mailing address
PSC 851 Box 340 Fpo
Manama, AE 09834
BH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2024. 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.