Provider Demographics
NPI:1386777100
Name:SAMANT, ASHA (DMD)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:SAMANT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5514
Mailing Address - Country:US
Mailing Address - Phone:973-972-4225
Mailing Address - Fax:973-972-0370
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:D830 NJDS UMDNJ
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-4225
Practice Address - Fax:973-972-0370
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ132101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics