Provider Demographics
NPI:1326075912
Name:MARKHAM, SAMUEL DARRELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DARRELL
Last Name:MARKHAM
Suffix:
Gender:M
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:PO BOX 100405
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0405
Mailing Address - Country:US
Mailing Address - Phone:352-273-5440
Mailing Address - Fax:352-392-3070
Practice Address - Street 1:340 NW 76TH DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-331-3113
Practice Address - Fax:352-331-5950
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 148911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice