Provider Demographics
NPI:1407851140
Name:GIGLIO, SAM CHARLES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:CHARLES
Last Name:GIGLIO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:STE 401
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3060
Mailing Address - Country:US
Mailing Address - Phone:409-898-8152
Mailing Address - Fax:409-898-3825
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:STE 401
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3060
Practice Address - Country:US
Practice Address - Phone:409-898-8152
Practice Address - Fax:409-898-3825
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX104011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice