Sami K. Banoub, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16659 Issued in FL

Practice address

752 Stirling Center PL
Suite 1000
Lake Mary, FL 32746-4889

Phone

(407) 915-5421

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405036800000",
    "number": "1699786152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "752 STIRLING CENTER PL",
            "address_2": "SUITE 1000",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464889",
            "telephone_number": "407-915-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "752 STIRLING CENTER PL",
            "address_2": "SUITE 1000",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327464889",
            "telephone_number": "407-915-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANOUB",
        "first_name": "SAMI",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2014-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN16659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naomi Balliston
• Lorne Balmer, BCBA
• Donna Harvel Balo, ARNP, CNM, MS
• Tiffany Joy Banas, M.A. SLP
• Carla Banks
• Marvin Barcenes
• Eva T. Barco, APRN
• Michelle Dellapenta Bargfrede, DMD
• Shea Rose West Barhite, BEHAVIOR TECHNICIAN
• Thomas A Barnard, MD

• General Practice Dentistry in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2014; 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.