Provider Demographics
NPI:1093049207
Name:INFANTINO, SAMUEL JOSEPH (DDS)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:INFANTINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10363 TORRE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3236
Mailing Address - Country:US
Mailing Address - Phone:408-252-8156
Mailing Address - Fax:408-252-8192
Practice Address - Street 1:10363 TORRE AVE STE F
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3236
Practice Address - Country:US
Practice Address - Phone:408-252-8156
Practice Address - Fax:408-252-8192
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist