Provider Demographics
NPI:1336210632
Name:SAMS, FREDERICK D (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:D
Last Name:SAMS
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 1:5732 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1741
Mailing Address - Country:US
Mailing Address - Phone:412-363-1821
Mailing Address - Fax:412-363-1824
Practice Address - Street 1:5732 ELLSWORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1741
Practice Address - Country:US
Practice Address - Phone:412-363-1821
Practice Address - Fax:412-363-1824
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024430L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice