Provider Demographics
NPI:1477753796
Name:SAMPLES, EDWARD CLARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CLARK
Last Name:SAMPLES
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 1:4001 E BELL ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-992-5600
Mailing Address - Fax:602-992-2442
Practice Address - Street 1:4001 E BELL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2242
Practice Address - Country:US
Practice Address - Phone:602-992-5600
Practice Address - Fax:602-992-2442
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice