Healthcare Provider Details

I. General information

NPI: 1528963840
Provider Name (Legal Business Name): SAM & POOJA DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13225 RIVERS BEND BLVD
CHESTER VA
23836-8605
US

IV. Provider business mailing address

13225 RIVERS BEND BLVD
CHESTER VA
23836-8605
US

V. Phone/Fax

Practice location:
  • Phone: 817-233-8386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: POOJA SAM
Title or Position: DENTIST
Credential: DDS
Phone: 479-312-2494