Provider Demographics
NPI:1972293520
Name:GIRARD, SAMANTHA (DDS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9579 S UNIVERSITY BLVD UNIT 400
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-8106
Mailing Address - Country:US
Mailing Address - Phone:337-212-9569
Mailing Address - Fax:
Practice Address - Street 1:9579 S UNIVERSITY BLVD UNIT 400
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-8106
Practice Address - Country:US
Practice Address - Phone:303-683-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODEN.002055991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program