Provider Demographics
NPI:1023685856
Name:SAMRIN, STEPHANIE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:SAMRIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 KIRKHAM ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3504
Mailing Address - Country:US
Mailing Address - Phone:203-488-6314
Mailing Address - Fax:
Practice Address - Street 1:62 KIRKHAM ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3504
Practice Address - Country:US
Practice Address - Phone:203-488-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT135001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program