Healthcare Provider Details

I. General information

NPI: 1831640523
Provider Name (Legal Business Name): SAMANTHA KEITH TILLAPAUGH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25200 LA PAZ RD STE 220
LAGUNA HILLS CA
92653-5136
US

IV. Provider business mailing address

953 LONGHORN WAY
RANCHO MISSION VIEJO CA
92694-1674
US

V. Phone/Fax

Practice location:
  • Phone: 949-325-3865
  • Fax:
Mailing address:
  • Phone: 949-923-9167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS100732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS100732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: