Provider Demographics
NPI:1356070825
Name:LEDUC, SAMANTHA H (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:H
Last Name:LEDUC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 DUSTY RHOADES LN
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5873
Mailing Address - Country:US
Mailing Address - Phone:802-318-7248
Mailing Address - Fax:
Practice Address - Street 1:138 HARRISON RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4748
Practice Address - Country:US
Practice Address - Phone:207-647-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN49611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice