1699270769 NPI number — DR. SAMIA KATE ARTHUR-BENTIL MD

Table of content: DR. SAMIA KATE ARTHUR-BENTIL MD (NPI 1699270769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699270769 NPI number — DR. SAMIA KATE ARTHUR-BENTIL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARTHUR-BENTIL
Provider First Name:
SAMIA KATE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699270769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4206 HAWTHORNE AVE APT 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75219-2330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-236-7209
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13747 MONTFORT DR STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-327-8188
Provider Business Practice Location Address Fax Number:
469-874-6771
Provider Enumeration Date:
03/29/2018

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: 2084P0800X , with the licence number:  S6117 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: S6117 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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