MEDICARE: FRANK CONKLIN SAMMIS III DDS MPH

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	1223G0001X	General Practice Dentistry	12061	TX

General Provider Information

NPI Number	:	1760599039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK CONKLIN SAMMIS III DDS MPH

Provider Business Mailing Address
First Line	:	7744 BROADWAY
Second Line	:	SUITE #203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3262
Country	:	US
Telephone Number	:	210-828-4990
Fax Number	:	210-828-0555

Provider Business Practice Location Address
First Line	:	7744 BROADWAY
Second Line	:	SUITE #203
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3262
Country	:	US
Telephone Number	:	210-828-4990
Fax Number	:	210-828-0555

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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