Provider Demographics
NPI:1780205005
Name:YOU, SAMANTHA ENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ENA
Last Name:YOU
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 1:521 NY-111
Mailing Address - Street 2:#106
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-1726
Mailing Address - Country:US
Mailing Address - Phone:631-361-6605
Mailing Address - Fax:
Practice Address - Street 1:521 NY-111
Practice Address - Street 2:#106
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-1726
Practice Address - Country:US
Practice Address - Phone:631-361-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061869011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice