Provider Demographics
NPI:1366821100
Name:SAMUELSON, DAVID BARROW (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BARROW
Last Name:SAMUELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BANBURY LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2504
Mailing Address - Country:US
Mailing Address - Phone:704-351-2273
Mailing Address - Fax:
Practice Address - Street 1:2 BANBURY LN
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2504
Practice Address - Country:US
Practice Address - Phone:704-351-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist