MEDICARE: SAMIS FAMILY DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1558256727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMIS FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	4554 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2954
Country	:	US
Telephone Number	:	708-952-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4554 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2954
Country	:	US
Telephone Number	:	708-952-0000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CRISTINA GALLEGOS
Credential	:
Telephone Number	:	312-568-9908

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	08/25/2025

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