Provider Demographics
NPI:1932837499
Name:LEMIEUX, SAMUEL MILES (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MILES
Last Name:LEMIEUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLIFF ST APT 20C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-0117
Mailing Address - Country:US
Mailing Address - Phone:913-634-9356
Mailing Address - Fax:
Practice Address - Street 1:2406 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3643
Practice Address - Country:US
Practice Address - Phone:201-866-9400
Practice Address - Fax:201-430-3000
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029203001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice