Provider Demographics
NPI:1346282753
Name:PHOTOPOULOS, SAM T (DDS)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:T
Last Name:PHOTOPOULOS
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 1:13774 FORTUNA CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5242
Mailing Address - Country:US
Mailing Address - Phone:408-867-2840
Mailing Address - Fax:408-377-9245
Practice Address - Street 1:2005 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2024
Practice Address - Country:US
Practice Address - Phone:408-377-9091
Practice Address - Fax:408-377-9245
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice