1780910745 NPI number — DR. SAMIR ABDERRAHMANE BENACHENHOU DDS

Table of content: DR. SAMIR ABDERRAHMANE BENACHENHOU DDS (NPI 1780910745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780910745 NPI number — DR. SAMIR ABDERRAHMANE BENACHENHOU DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENACHENHOU
Provider First Name:
SAMIR
Provider Middle Name:
ABDERRAHMANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENACHENHOU
Provider Other First Name:
ABDERRAHMANE
Provider Other Middle Name:
SAMIR
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780910745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BAUGHMANS LN
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21702-4894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-662-0554
Provider Business Mailing Address Fax Number:
301-662-0587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BAUGHMANS LN
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-662-0554
Provider Business Practice Location Address Fax Number:
301-662-0587
Provider Enumeration Date:
10/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12621 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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