Provider Demographics
NPI:1184209967
Name:SAMUELS, JASMYNE (DDS)
Entity Type:Individual
Prefix:
First Name:JASMYNE
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N GRANT ST APT 719
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1573
Mailing Address - Country:US
Mailing Address - Phone:503-758-6727
Mailing Address - Fax:
Practice Address - Street 1:6200 S MCCLINTOCK DR STE 111
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3449
Practice Address - Country:US
Practice Address - Phone:480-664-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program