Provider Demographics
NPI:1104042456
Name:REED, SAMANTHA PAULETTE (DMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAULETTE
Last Name:REED
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:PAULETTE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2707 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3312
Mailing Address - Country:US
Mailing Address - Phone:727-785-6521
Mailing Address - Fax:727-785-6237
Practice Address - Street 1:2707 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3312
Practice Address - Country:US
Practice Address - Phone:727-785-6521
Practice Address - Fax:727-785-6237
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice