Provider Demographics
NPI:1770660508
Name:EISENSTEIN, SAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12333 NW 18TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4386
Mailing Address - Country:US
Mailing Address - Phone:954-435-4100
Mailing Address - Fax:954-435-1459
Practice Address - Street 1:12333 NW 18TH STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4386
Practice Address - Country:US
Practice Address - Phone:954-435-4100
Practice Address - Fax:954-435-1459
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN88491223P0221X
MA122491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE1269023OtherDEA USA DEPT OF JUSTICE