Provider Demographics
NPI:1881288058
Name:SAMANTHA JETTE DDS - PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SAMANTHA JETTE DDS - PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-282-1640
Mailing Address - Street 1:103 STEELE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1068
Mailing Address - Country:US
Mailing Address - Phone:304-842-0441
Mailing Address - Fax:
Practice Address - Street 1:103 STEELE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1068
Practice Address - Country:US
Practice Address - Phone:304-842-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental