Provider Demographics
NPI:1780486100
Name:SAMS, CANDICE MICHELLE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MICHELLE
Last Name:SAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 SANTA SABINA DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8729
Mailing Address - Country:US
Mailing Address - Phone:469-724-0847
Mailing Address - Fax:
Practice Address - Street 1:2956 SANTA SABINA DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8729
Practice Address - Country:US
Practice Address - Phone:469-724-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty