Provider Demographics
NPI:1013299338
Name:SAMARKOS, D.M.D., P.A.
Entity Type:Organization
Organization Name:SAMARKOS, D.M.D., P.A.
Other - Org Name:DUNNELLON DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-489-3922
Mailing Address - Street 1:11223 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-8350
Mailing Address - Country:US
Mailing Address - Phone:352-489-3922
Mailing Address - Fax:
Practice Address - Street 1:11223 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-8350
Practice Address - Country:US
Practice Address - Phone:352-489-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12788261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1669682266OtherNPI 1
FL1467781112OtherNPI 1
FL187170330OtherNPI 1
FL1154630341OtherNPI 1
FL2802037313OtherNPI 1