Healthcare Provider Details

I. General information

NPI: 1437347283
Provider Name (Legal Business Name): SAMUEL DAVID ARCHIBALD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18335 E 103RD AVE UNIT 101
COMMERCE CITY CO
80022-3103
US

IV. Provider business mailing address

18335 E 103RD AVE UNIT 101
COMMERCE CITY CO
80022-3103
US

V. Phone/Fax

Practice location:
  • Phone: 303-286-8700
  • Fax: 303-286-8701
Mailing address:
  • Phone: 303-286-8700
  • Fax: 303-286-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number55186
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9524
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: