Provider Demographics
NPI:1225851090
Name:ADELI, SAMAA (DMD)
Entity type:Individual
Prefix:
First Name:SAMAA
Middle Name:
Last Name:ADELI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1339
Mailing Address - Country:US
Mailing Address - Phone:708-435-3119
Mailing Address - Fax:
Practice Address - Street 1:4 W BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-1629
Practice Address - Country:US
Practice Address - Phone:708-435-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist