Provider Demographics
NPI:1063471472
Name:SAMUELS, RISA CHERYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:CHERYL
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61-17 220TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2244
Mailing Address - Country:US
Mailing Address - Phone:718-225-3050
Mailing Address - Fax:718-225-5609
Practice Address - Street 1:61-17 220TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2244
Practice Address - Country:US
Practice Address - Phone:718-225-3050
Practice Address - Fax:718-225-5609
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01180501Medicaid