Provider Demographics
NPI:1023170883
Name:HASHEMIAN, SAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:HASHEMIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 W INDIAN SCHOOL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4928
Mailing Address - Country:US
Mailing Address - Phone:623-536-7789
Mailing Address - Fax:623-536-4743
Practice Address - Street 1:13575 W INDIAN SCHOOL RD STE 300
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4928
Practice Address - Country:US
Practice Address - Phone:623-536-7789
Practice Address - Fax:623-536-4743
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6661122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist