Provider Demographics
NPI:1568541753
Name:HAM, SAMUEL SAEHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SAEHO
Last Name:HAM
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 1:11230 WAPLES MILL ROAD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-691-2221
Mailing Address - Fax:703-691-3215
Practice Address - Street 1:11230 WAPLES MILL ROAD
Practice Address - Street 2:SUITE 160
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:703-691-2221
Practice Address - Fax:703-691-3215
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist