Provider Demographics
NPI:1922794452
Name:SAMANTHA IFILL DDS PLLC
Entity Type:Organization
Organization Name:SAMANTHA IFILL DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:IFILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-230-3183
Mailing Address - Street 1:511 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2246
Mailing Address - Country:US
Mailing Address - Phone:718-230-3183
Mailing Address - Fax:347-705-0795
Practice Address - Street 1:511 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2246
Practice Address - Country:US
Practice Address - Phone:718-230-3183
Practice Address - Fax:347-705-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty