Provider Demographics
NPI:1538472709
Name:SAMPERI, JEANINE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:MARIE
Last Name:SAMPERI
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 1:385 CALLE DE ALEGRA, BLDG. A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3417
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:
Practice Address - Street 1:855 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9325
Practice Address - Country:US
Practice Address - Phone:575-882-3607
Practice Address - Fax:575-882-2909
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00255731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM31477071Medicaid