Provider Demographics
NPI:1104845007
Name:ORME, SAMUEL COLLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:COLLIN
Last Name:ORME
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 STATE ROUTE 17C
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-9507
Mailing Address - Country:US
Mailing Address - Phone:607-565-7811
Mailing Address - Fax:607-565-7165
Practice Address - Street 1:284 STATE ROUTE 17C
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-9507
Practice Address - Country:US
Practice Address - Phone:607-565-7811
Practice Address - Fax:607-565-7165
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0314181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015173780002Medicaid
NY00464966Medicaid