MEDICARE: SAMUELS MOBILE DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1598536716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUELS MOBILE DENTAL PLLC

Provider Business Mailing Address
First Line	:	155 RIDGELEY CIR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23505-4609
Country	:	US
Telephone Number	:	504-905-1394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 MILLERS LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5716
Country	:	US
Telephone Number	:	948-203-9545
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC SCOTT SAMUELS
Credential	:	DMD
Telephone Number	:	504-905-1394

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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