Provider Demographics
NPI:1598536716
Name:SAMUELS MOBILE DENTAL PLLC
Entity Type:Organization
Organization Name:SAMUELS MOBILE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:504-905-1394
Mailing Address - Street 1:155 RIDGELEY CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4609
Mailing Address - Country:US
Mailing Address - Phone:504-905-1394
Mailing Address - Fax:
Practice Address - Street 1:1164 MILLERS LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5716
Practice Address - Country:US
Practice Address - Phone:948-203-9545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental