Provider Demographics
NPI:1336205251
Name:MUMPOWER, SAMUEL JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAMES
Last Name:MUMPOWER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 J L TODD DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5015
Mailing Address - Country:US
Mailing Address - Phone:706-291-0095
Mailing Address - Fax:706-291-0036
Practice Address - Street 1:160 THREE RIVERS DR NE
Practice Address - Street 2:SUITE 1600
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2303
Practice Address - Country:US
Practice Address - Phone:706-291-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0122001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics