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General NPI Number Information
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NPI Number | 1174362008
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Entity Type | Individual
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Provider Name | SAMTA RAJAN D.M.D
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Gender | Female
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 2303 S MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1566
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Country | US
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Telephone | 937-595-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 2303 S MAIN ST
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-1566
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Country | US
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Telephone | 937-595-0080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.027541
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.027541
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License Number State | OH
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