Provider Demographics
NPI:1316088529
Name:POIDMORE, SAM JOSEPH (D,D,S,)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:JOSEPH
Last Name:POIDMORE
Suffix:
Gender:M
Credentials:D,D,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18152 PAMELA PL
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-2626
Mailing Address - Country:US
Mailing Address - Phone:714-921-9662
Mailing Address - Fax:714-921-9667
Practice Address - Street 1:18152 PAMELA PL
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861-2626
Practice Address - Country:US
Practice Address - Phone:714-921-9662
Practice Address - Fax:714-921-9667
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD-243271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery