Provider Demographics
NPI:1013466630
Name:AGUIRRE, SAMANTHA (DDS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:AGUIRRE
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 1:740 SOLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2423 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2830
Practice Address - Country:US
Practice Address - Phone:602-803-3977
Practice Address - Fax:530-838-9026
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008311223D0001X
AZD011705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health