1023636446 NPI number — DR. JOSEPH SAMONA DDS

Table of content: DR. JOSEPH SAMONA DDS (NPI 1023636446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023636446 NPI number — DR. JOSEPH SAMONA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMONA
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023636446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UT HEALTH SCIENCE CENTER AT SAN ANTONIO
Provider Second Line Business Mailing Address:
8210 FLOYD CURL DRIVE, MSC 8103
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-3923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-450-3273
Provider Business Mailing Address Fax Number:
210-450-2223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39242 DEQUINDRE RD STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48310-1767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-795-5678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  ETN763 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 2901600830 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com