Healthcare Provider Details

I. General information

NPI: 1134911647
Provider Name (Legal Business Name): SAMANTHA LINA YANCY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 THOMAS JOHNSON DR STE 200
FREDERICK MD
21702-4532
US

IV. Provider business mailing address

145 GEORGETOWN RD
ANNAPOLIS MD
21403-3414
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-4012
  • Fax:
Mailing address:
  • Phone: 920-980-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19147
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number600178615
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: