Provider Demographics
NPI:1407421290
Name:DUFINETZ, SAMANTHA TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:TAYLOR
Last Name:DUFINETZ
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 1:2017 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1634
Mailing Address - Country:US
Mailing Address - Phone:317-518-7695
Mailing Address - Fax:
Practice Address - Street 1:2500 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1111
Practice Address - Country:US
Practice Address - Phone:216-860-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0265091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice