Provider Demographics
NPI:1073871448
Name:ODERA, SAMPETER LIECH (MD, DMD)
Entity Type:Individual
Prefix:
First Name:SAMPETER
Middle Name:LIECH
Last Name:ODERA
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSF ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - Street 2:513 PARNASSUS S738
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-3242
Mailing Address - Fax:
Practice Address - Street 1:UCSF ORAL AND MAXILLOFACIAL SURGERY
Practice Address - Street 2:513 PARNASSUS S738
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-476-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18564601223S0112X
CAA127360204E00000X
CAOMS106204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery