Provider Demographics
NPI:1184918823
Name:ELBATANOUNY, SAMER M (BDS, DDS)
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:M
Last Name:ELBATANOUNY
Suffix:
Gender:M
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4630
Mailing Address - Country:US
Mailing Address - Phone:630-632-4100
Mailing Address - Fax:
Practice Address - Street 1:432 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4630
Practice Address - Country:US
Practice Address - Phone:630-629-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-29
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist