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General NPI Number Information
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NPI Number | 1366215923
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Entity Type | Individual
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Provider Name | SAMANTHA SCHALLER DMD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 15717 BERNARDO HEIGHTS PKWY
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City | SAN DIEGO
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State | CA
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Zip | 92128-3155
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Country | US
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Telephone | 858-451-4413
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Fax |
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Provider Business Mailing Address
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Address Line | 4228 FANUEL ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-8705
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 109632
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License Number State | CA
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