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General NPI Number Information
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NPI Number | 1760798979
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Entity Type | Individual
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Provider Name | KISHORE SAMA BDS, MSD.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 1110 W WILLIAM CANNON DR STE 401
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City | AUSTIN
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State | TX
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Zip | 78745-5498
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Country | US
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Telephone | 512-445-5811
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 W WILLIAM CANNON DR STE 401
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City | AUSTIN
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State | TX
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Zip | 78745-5468
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Country | US
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Telephone | 512-445-5811
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 28488
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License Number State | TX
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