Provider Demographics
NPI:1629194535
Name:HOLDER, SAMANTHA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LYNN
Last Name:HOLDER
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 1:653 E SIPAPU DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1393
Mailing Address - Country:US
Mailing Address - Phone:708-334-6036
Mailing Address - Fax:
Practice Address - Street 1:7595 E MCDONALD DR STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6080
Practice Address - Country:US
Practice Address - Phone:480-757-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190270571223G0001X
AZD009694122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice