Provider Demographics
NPI:1649618802
Name:ANNAS, SAMANTHA JOALICE (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JOALICE
Last Name:ANNAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6458
Mailing Address - Country:US
Mailing Address - Phone:352-332-8199
Mailing Address - Fax:
Practice Address - Street 1:908 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6458
Practice Address - Country:US
Practice Address - Phone:352-332-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN201131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice