Provider Demographics
NPI:1245373141
Name:SAMPSON, AUSTIN H (DDS)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:H
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2140
Mailing Address - Country:US
Mailing Address - Phone:727-784-6822
Mailing Address - Fax:
Practice Address - Street 1:2555 ENTERPRISE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1160
Practice Address - Country:US
Practice Address - Phone:727-796-8891
Practice Address - Fax:727-796-8880
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice