Healthcare Provider Details

I. General information

NPI: 1508346602
Provider Name (Legal Business Name): SAMANTHA NICOLE DAHLBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13917 W HIGHWAY 71 STE A
AUSTIN TX
78738-3008
US

IV. Provider business mailing address

3505 BEAR CLAW
LEANDER TX
78641-3693
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-7030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number208D00000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT8757
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: