Provider Demographics
NPI:1831226695
Name:SAM DANIELDASON DDS APDC
Entity type:Organization
Organization Name:SAM DANIELDASON DDS APDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DASON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-884-6125
Mailing Address - Street 1:575 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1301
Mailing Address - Country:US
Mailing Address - Phone:909-884-6125
Mailing Address - Fax:909-885-7556
Practice Address - Street 1:575 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1301
Practice Address - Country:US
Practice Address - Phone:909-884-6125
Practice Address - Fax:909-885-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty