Provider Demographics
NPI:1164101705
Name:GAITO, SAMANTHA MULLIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MULLIS
Last Name:GAITO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 SPRING FARM GATE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-2748
Mailing Address - Country:US
Mailing Address - Phone:864-423-0397
Mailing Address - Fax:
Practice Address - Street 1:108 PARISH FARMS DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-0409
Practice Address - Country:US
Practice Address - Phone:843-419-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.106021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice