Provider Demographics
NPI:1003592346
Name:PHELIX, SAMANTHA L (DDS)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:L
Last Name:PHELIX
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 1:4325 GERRARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3449
Mailing Address - Country:US
Mailing Address - Phone:304-229-2181
Mailing Address - Fax:304-229-2291
Practice Address - Street 1:4325 GERRARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3449
Practice Address - Country:US
Practice Address - Phone:304-229-2181
Practice Address - Fax:304-229-2291
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice