Provider Demographics
NPI:1154347938
Name:DOMSKY, SAMUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:DOMSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ARMSTRONG CIR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1865
Mailing Address - Country:US
Mailing Address - Phone:215-579-7047
Mailing Address - Fax:215-579-7725
Practice Address - Street 1:3103 HULMEVILLE RD
Practice Address - Street 2:SUITE #205
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4365
Practice Address - Country:US
Practice Address - Phone:215-639-5331
Practice Address - Fax:215-639-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023211-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist