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General NPI Number Information
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NPI Number | 1457911513
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Entity Type | Individual
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Provider Name | DR. SAMUEL DASTRUP
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Gender | Male
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 430 S SALISBURY AVE
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City | SPENCER
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State | NC
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Zip | 28159-2239
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Country | US
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Telephone | 801-821-8982
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Fax |
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Provider Business Mailing Address
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Address Line | 2577 SHOAL PARK RD
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City | CONCORD
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State | NC
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Zip | 28027-2871
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Country | US
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Telephone | 801-821-8982
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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 | 14450
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License Number State | NC
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