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General NPI Number Information
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NPI Number | 1225147168
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Entity Type | Individual
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Provider Name | VIDHYALAKSHMI SAMPATH B.D.S., D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 3003 W 104TH AVE UNIT 300 BRIGHT NOW DENTAL (MODERN DENTAL PROFESSIONALS- CO PC)
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City | WESTMINSTER
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State | CO
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Zip | 80031-7752
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Country | US
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Telephone | 303-410-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 W 104TH AVE UNIT 300 BRIGHT NOW DENTAL (MODERN DENTAL PROFESSIONALS- CO PC)
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City | WESTMINSTER
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State | CO
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Zip | 80031-7752
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Country | US
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Telephone | 303-410-9800
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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 | 051745-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN 9235
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License Number State | CO
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