Healthcare Provider Details

I. General information

NPI: 1770660508
Provider Name (Legal Business Name): SAM EISENSTEIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12333 NW 18TH STREET SUITE 4
PEMBROKE PINES FL
33026-4386
US

IV. Provider business mailing address

12333 NW 18TH STREET SUITE 4
PEMBROKE PINES FL
33026-4386
US

V. Phone/Fax

Practice location:
  • Phone: 954-435-4100
  • Fax: 954-435-1459
Mailing address:
  • Phone: 954-435-4100
  • Fax: 954-435-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN8849
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12249
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: