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General NPI Number Information
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NPI Number | 1740331925
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Entity Type | Individual
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Provider Name | SAMUEL S WAKIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 1927 S HWY 27
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 352-432-8269
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Fax |
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Provider Business Mailing Address
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Address Line | 15150 SHONAN GOLD DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5684
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Country | US
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Telephone | 530-524-7338
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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 | 40509
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License Number State | CA
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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 | 12011100A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36188
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN23028
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License Number State | FL
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