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General NPI Number Information
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NPI Number | 1912880063
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Entity Type | Individual
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Provider Name | JAZMYN TORI SAMPSON
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Gender | Female
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 10040 ALTA DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89145-8630
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Country | US
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Telephone | 702-425-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 8883 ROADRUNNER RAVINE ST
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City | LAS VEGAS
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State | NV
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Zip | 89166-6726
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Country | US
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Telephone | 435-705-9622
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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 | 8241
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License Number State | NV
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