Provider Demographics
NPI:1821788696
Name:RAMIREZ, SAMUEL BENJAMIN
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 W WARNER RD STE 21
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-8704
Mailing Address - Country:US
Mailing Address - Phone:480-917-0181
Mailing Address - Fax:
Practice Address - Street 1:2051 W WARNER RD STE 21
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8704
Practice Address - Country:US
Practice Address - Phone:480-917-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD012220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program