Ivan Mark Samano, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

18371 Issued in MI

Practice address

50 W Big Beaver
Ste 100 a
Bloomfield Hills, MI 48304

Phone

(248) 290-2900

Fax

(248) 290-2904

NPI assigned

Oct 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• TMJ and Sleep of SE Michigan

  • Dental Clinic/Center
  • Bloomfield, MI
  • NPI 1285003905
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659468361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 W BIG BEAVER",
            "address_2": "STE 100 A",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "48304",
            "telephone_number": "248-290-2900",
            "fax_number": "248-290-2904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 W BIG BEAVER",
            "address_2": "STE 100 A",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "48304",
            "telephone_number": "248-290-2900",
            "fax_number": "248-290-2904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMANO",
        "first_name": "IVAN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "18371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0183710",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4852555",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1811510",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rima Sakr
• Vanessa N. Salliotte
• Anan Salloum
• Sally Bloch PHD LP PLLC
• Samano & Kejbou Dental, PC (Bloomfield Hills Dental Associates)
• Ahmad M Samhouri, M.D.
• Michael Kovel Samson, M.D.
• Samuelson Enterprises, PLLC (Grace Wellness Clinic)
• Angela Patricia Sanchez, DPT
• Sanctum Medical, PLLC

• Dentist in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.