Provider Demographics
NPI:1629259270
Name:FIRST, SAMUEL (DSS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:FIRST
Suffix:
Gender:M
Credentials:DSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1602
Mailing Address - Country:US
Mailing Address - Phone:516-432-3200
Mailing Address - Fax:516-379-8000
Practice Address - Street 1:1469 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1602
Practice Address - Country:US
Practice Address - Phone:516-432-3200
Practice Address - Fax:516-379-8000
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice