Provider Demographics
NPI:1669653754
Name:GELUDA-LEWIN, SAMANTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:GELUDA-LEWIN
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 1:900 N MIAMI BEACH BLVD
Mailing Address - Street 2:K-MART DENTAL OFFICE
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3716
Mailing Address - Country:US
Mailing Address - Phone:305-947-9001
Mailing Address - Fax:
Practice Address - Street 1:900 N MIAMI BEACH BLVD
Practice Address - Street 2:K-MART DENTAL OFFICE
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3716
Practice Address - Country:US
Practice Address - Phone:305-947-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2007-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02703226Medicaid