Healthcare Provider Details

I. General information

NPI: 1588328793
Provider Name (Legal Business Name): BRIAN SAMPAYO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 N MCMULLEN BOOTH RD
CLEARWATER FL
33761-2032
US

IV. Provider business mailing address

3165 N MCMULLEN BOOTH RD
CLEARWATER FL
33761-2032
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-2183
  • Fax:
Mailing address:
  • Phone: 786-486-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN26493
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN26493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: