Provider Demographics
NPI:1962673798
Name:ROWE, SAMUEL VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:VICTOR
Last Name:ROWE
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 1:605 CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-8353
Mailing Address - Country:US
Mailing Address - Phone:772-461-2648
Mailing Address - Fax:772-461-2691
Practice Address - Street 1:605 CITRUS AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-8353
Practice Address - Country:US
Practice Address - Phone:772-461-2648
Practice Address - Fax:772-461-2691
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 10612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist