Provider Demographics
NPI:1972271773
Name:VEST, SAMANTHA CLARA (BSDH, RDH)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:CLARA
Last Name:VEST
Suffix:
Gender:F
Credentials:BSDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W BAYVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4745
Mailing Address - Country:US
Mailing Address - Phone:302-745-2844
Mailing Address - Fax:
Practice Address - Street 1:1658 PLEASURE HOUSE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-4051
Practice Address - Country:US
Practice Address - Phone:757-464-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207874124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist