Individual
MOHAMMED M ALSAMARRAIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1300 W LINCOLN AVE, MILWAUKEE, WI 53215-3127
(414) 377-3808
Mailing address
2501 W GRENSHAW ST UNIT 1W, CHICAGO, IL 60612-4816
(703) 474-5757
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019-031096
IL
122300000X
Dentist
Primary
1001540-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689102667
—
WI
Enumeration date
06/02/2017
Last updated
03/17/2018
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