Provider Demographics
NPI:1487037610
Name:DUBIN, SAMANTHA (DMD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DUBIN
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 1:7633 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 70
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3730
Mailing Address - Country:US
Mailing Address - Phone:313-499-4775
Mailing Address - Fax:313-499-4953
Practice Address - Street 1:7633 E JEFFERSON AVE
Practice Address - Street 2:SUITE 70
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-499-4775
Practice Address - Fax:313-499-4953
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program