Healthcare Provider Details

I. General information

NPI: 1710812334
Provider Name (Legal Business Name): SAMUEL FREDERICK ALTMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 12TH ST
PLUMMER ID
83851-4000
US

IV. Provider business mailing address

638 HORSE JUMP DR
CLE ELUM WA
98922-5815
US

V. Phone/Fax

Practice location:
  • Phone: 208-686-1931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9481417
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: