Provider Demographics
NPI:1790724763
Name:D'ARCO, SAMUEL CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CHRISTOPHER
Last Name:D'ARCO
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 1:3736 WALTON WAY EXT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2402
Mailing Address - Country:US
Mailing Address - Phone:706-228-3100
Mailing Address - Fax:706-228-3707
Practice Address - Street 1:3736 WALTON WAY EXT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2402
Practice Address - Country:US
Practice Address - Phone:706-228-3100
Practice Address - Fax:706-228-3707
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0111301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00707407BMedicaid
GA19NCCCTMedicare ID - Type Unspecified
GA00707407BMedicaid