Provider Demographics
NPI:1629373592
Name:SAMUEL, STANLEY (DDS)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S FEDERAL BLVD
Mailing Address - Street 2:G-2
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2975
Mailing Address - Country:US
Mailing Address - Phone:303-795-1107
Mailing Address - Fax:303-795-1196
Practice Address - Street 1:5151 S FEDERAL BLVD
Practice Address - Street 2:G-2
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2975
Practice Address - Country:US
Practice Address - Phone:303-795-1107
Practice Address - Fax:303-795-1196
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice