Provider Demographics
NPI:1417366345
Name:YORK, SAMANTHA HUBBS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:HUBBS
Last Name:YORK
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:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-0961
Mailing Address - Country:US
Mailing Address - Phone:979-964-3226
Mailing Address - Fax:
Practice Address - Street 1:11034 S HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422-8375
Practice Address - Country:US
Practice Address - Phone:979-798-2188
Practice Address - Fax:979-798-6511
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX-14595122300000X
TXF00602261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122300000XOtherTAXONOMY