Provider Demographics
NPI:1093976383
Name:SAMSON, WILLIAM ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:SAMSON
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 1:3997 VALLEY COMMONS DRIVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-404-1186
Mailing Address - Fax:406-404-1187
Practice Address - Street 1:3997 VALLEY COMMONS DRIVE SUITE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4108
Practice Address - Country:US
Practice Address - Phone:406-404-1186
Practice Address - Fax:406-404-1187
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR418122300000X
MT23491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7133568Medicaid