Provider Demographics
NPI:1487732178
Name:SAMUELS, ALLAN D (DMD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:D
Last Name:SAMUELS
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 1:8016 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3056
Mailing Address - Country:US
Mailing Address - Phone:215-482-8600
Mailing Address - Fax:215-482-0101
Practice Address - Street 1:8016 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3056
Practice Address - Country:US
Practice Address - Phone:215-482-8600
Practice Address - Fax:215-482-0101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 016825L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice