Healthcare Provider Details

I. General information

NPI: 1487037610
Provider Name (Legal Business Name): SAMANTHA DUBIN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 GRANT ST STE 300
NORTHGLENN CO
80233-1117
US

IV. Provider business mailing address

5411 E BAILS DR
DENVER CO
80222-3961
US

V. Phone/Fax

Practice location:
  • Phone: 303-500-5529
  • Fax:
Mailing address:
  • Phone: 626-244-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2603
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN00204671
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: