Healthcare Provider Details

I. General information

NPI: 1982130779
Provider Name (Legal Business Name): SAMUEL VOTTO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

3637 RICHMOND ST
JACKSONVILLE FL
32205-9457
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7300
  • Fax:
Mailing address:
  • Phone: 215-776-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number110745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number33185
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN31531
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: