=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689558363
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMANTHA DE LEON TILLAPAUGH DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25200 LA PAZ RD STE 220
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-923-9167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 953 LONGHORN WAY
-----------------------------------------------------
City | RANCHO MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92694-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-923-9167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SAMANTHA TILLAPAUGH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 949-923-9167
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------