MEDICARE: DR. JORGE FREDDY SAMANEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DI19147	NJ

General Provider Information

NPI Number	:	1730287103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE FREDDY SAMANEZ DDS

Provider Business Mailing Address
First Line	:	1078 E 25TH ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07513-1632
Country	:	US
Telephone Number	:	973-742-5827
Fax Number	:	973-742-8149

Provider Business Practice Location Address
First Line	:	1078 E 25TH ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07513-1632
Country	:	US
Telephone Number	:	973-742-5827
Fax Number	:	973-742-8149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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