Provider Demographics
NPI:1821201450
Name:GOBY, SAMUEL MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MARK
Last Name:GOBY
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 1:1217 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5617
Mailing Address - Country:US
Mailing Address - Phone:916-441-2366
Mailing Address - Fax:916-441-5929
Practice Address - Street 1:1217 26TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5617
Practice Address - Country:US
Practice Address - Phone:916-441-2366
Practice Address - Fax:916-441-5929
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics