Provider Demographics
NPI:1326069451
Name:GITTINGS, SAMUEL EVANS (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EVANS
Last Name:GITTINGS
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 1:3435 VALLE VERDE DR STE A
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2408
Mailing Address - Country:US
Mailing Address - Phone:707-253-2770
Mailing Address - Fax:707-253-2775
Practice Address - Street 1:3435 VALLE VERDE DR STE A
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2408
Practice Address - Country:US
Practice Address - Phone:707-253-2770
Practice Address - Fax:707-253-2775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92819-01OtherMEDI-CAL