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General NPI Number Information
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NPI Number | 1700254034
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Entity Type | Individual
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Provider Name | SAMANTHA JETTE D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 02/20/2021
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Provider Practice Location Address
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Address Line | 103 STEELE ST
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1068
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Country | US
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Telephone | 304-282-1640
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Fax |
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Provider Business Mailing Address
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Address Line | 63 KINGSTON DR
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1587
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Country | US
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Telephone | 304-282-1640
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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 | 4186
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License Number State | WV
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