Provider Demographics
NPI:1700507951
Name:ALLEN, SAMANTHA LEIGH (DMD)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:ALLEN
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 1:207 S POCAHONTAS STREET
Mailing Address - Street 2:
Mailing Address - City:SARDIS
Mailing Address - State:MS
Mailing Address - Zip Code:38666
Mailing Address - Country:US
Mailing Address - Phone:228-342-6823
Mailing Address - Fax:
Practice Address - Street 1:207 S POCAHONTAS ST
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-1625
Practice Address - Country:US
Practice Address - Phone:228-342-6823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4320-22122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist