Provider Demographics
NPI:1104848415
Name:SAMPSON, STEPHEN MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARVIN
Last Name:SAMPSON
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 1:108 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16950-1605
Mailing Address - Country:US
Mailing Address - Phone:814-367-5501
Mailing Address - Fax:
Practice Address - Street 1:108 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:PA
Practice Address - Zip Code:16950-1605
Practice Address - Country:US
Practice Address - Phone:814-367-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021305L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice