Provider Demographics
NPI:1629050158
Name:KOLINSKI, SAMANTHA T (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:T
Last Name:KOLINSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 E. BASELINE ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-218-6000
Mailing Address - Fax:480-985-4118
Practice Address - Street 1:4915 E. BASELINE ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-218-6000
Practice Address - Fax:480-985-4118
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ921777Medicare ID - Type Unspecified