Provider Demographics
NPI:1427238575
Name:SAMUEL, HEMANTH KUMAR (DDS)
Entity type:Individual
Prefix:
First Name:HEMANTH
Middle Name:KUMAR
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E FAIRMONT PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6498
Mailing Address - Country:US
Mailing Address - Phone:281-470-2749
Mailing Address - Fax:281-470-0905
Practice Address - Street 1:410 E FAIRMONT PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6498
Practice Address - Country:US
Practice Address - Phone:281-470-2749
Practice Address - Fax:281-470-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560301223G0001X
TX253621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216164801Medicaid