Provider Demographics
NPI:1851383848
Name:CALLAHAN, SAMANTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:33600 N 27TH DR
Mailing Address - Street 2:UNIT #1012
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7771
Mailing Address - Country:US
Mailing Address - Phone:770-855-3045
Mailing Address - Fax:
Practice Address - Street 1:475 E BELL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-2348
Practice Address - Country:US
Practice Address - Phone:623-866-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN110781223D0001X
NC060161223G0001X
AZ9185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice