1477676633 NPI number — SAM E ENGLISH II DDS LLC

Table of content: (NPI 1477676633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477676633 NPI number — SAM E ENGLISH II DDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM E ENGLISH II DDS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477676633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 945
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23181-0945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-843-3233
Provider Business Mailing Address Fax Number:
804-843-4033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
798 SOUTHPARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 26
Provider Business Practice Location Address City Name:
COLONIAL HEIGHTS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23834-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-520-1177
Provider Business Practice Location Address Fax Number:
804-520-4007
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ENGLISH
Authorized Official First Name:
SAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
804-843-3233

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401004082 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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