Provider Demographics
NPI:1578636551
Name:ARTLEY, SAMUEL BERESFORD (DMD,FAGD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BERESFORD
Last Name:ARTLEY
Suffix:
Gender:M
Credentials:DMD,FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 DURHAM DR
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7610
Mailing Address - Country:US
Mailing Address - Phone:321-733-4711
Mailing Address - Fax:321-733-8828
Practice Address - Street 1:4545 DURHAM DR
Practice Address - Street 2:
Practice Address - City:W MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7610
Practice Address - Country:US
Practice Address - Phone:321-733-4711
Practice Address - Fax:321-733-8828
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice