Healthcare Provider Details

I. General information

NPI: 1043520224
Provider Name (Legal Business Name): SAMANTHA HINDUPUR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 W US HIGHWAY 71
SAVANNAH MO
64485-1151
US

IV. Provider business mailing address

2303 VILLAGE DR
SAINT JOSEPH MO
64506-4954
US

V. Phone/Fax

Practice location:
  • Phone: 816-324-5644
  • Fax:
Mailing address:
  • Phone: 816-307-4893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number60740
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number057709
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2009028412
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number319017551
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: