Provider Demographics
NPI:1598837460
Name:FREDERICK H SAMMONS DDS LTD
Entity Type:Organization
Organization Name:FREDERICK H SAMMONS DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SAMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:304-522-3512
Mailing Address - Street 1:1040 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703
Mailing Address - Country:US
Mailing Address - Phone:304-522-3512
Mailing Address - Fax:304-522-6233
Practice Address - Street 1:1040 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703
Practice Address - Country:US
Practice Address - Phone:304-522-3512
Practice Address - Fax:304-522-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022161Medicaid