Provider Demographics
NPI:1174605034
Name:SAMUEL, ANDREW RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:SAMUEL
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 1:1300 STATE ROUTE 35
Mailing Address - Street 2:PLAZA 1, SUITE 203
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3537
Mailing Address - Country:US
Mailing Address - Phone:732-517-9800
Mailing Address - Fax:732-517-0319
Practice Address - Street 1:1300 STATE ROUTE 35
Practice Address - Street 2:PLAZA 1, SUITE 203
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3537
Practice Address - Country:US
Practice Address - Phone:732-517-9800
Practice Address - Fax:732-517-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019370001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics