Provider Demographics
NPI:1972629921
Name:SAMS, MARQUEZ JAMAR (DMD)
Entity Type:Individual
Prefix:
First Name:MARQUEZ
Middle Name:JAMAR
Last Name:SAMS
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 1:555 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4506
Mailing Address - Country:US
Mailing Address - Phone:316-683-2525
Mailing Address - Fax:316-683-9385
Practice Address - Street 1:555 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4506
Practice Address - Country:US
Practice Address - Phone:316-683-2525
Practice Address - Fax:316-683-9385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics