Provider Demographics
NPI:1497461024
Name:SAM DENTAL PLLC
Entity Type:Organization
Organization Name:SAM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMU
Authorized Official - Middle Name:
Authorized Official - Last Name:VUPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-819-8189
Mailing Address - Street 1:5002 APPLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4410 N MIDKIFF RD STE D1
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4249
Practice Address - Country:US
Practice Address - Phone:419-819-8189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty