Healthcare Provider Details

I. General information

NPI: 1851383848
Provider Name (Legal Business Name): SAMANTHA CALLAHAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA CALLAHAN D.D.S.

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E BELL RD SUITE 150
PHOENIX AZ
85022-2348
US

IV. Provider business mailing address

33600 N 27TH DR UNIT #1012
PHOENIX AZ
85085-7771
US

V. Phone/Fax

Practice location:
  • Phone: 623-866-5581
  • Fax:
Mailing address:
  • Phone: 770-855-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN11078
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number06016
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9185
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: