Provider Demographics
NPI:1245614791
Name:TEJADA, SAMANTHA LEA (DDS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEA
Last Name:TEJADA
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 1:24527 GOSLING RD # D-120
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-3214
Mailing Address - Country:US
Mailing Address - Phone:832-930-7795
Mailing Address - Fax:
Practice Address - Street 1:24527 GOSLING RD # D-120
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-3214
Practice Address - Country:US
Practice Address - Phone:832-930-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist