Provider Demographics
NPI:1457335366
Name:SAMPSON, ALAN DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1795 MAIN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1015
Mailing Address - Country:US
Mailing Address - Phone:413-737-6322
Mailing Address - Fax:413-731-9377
Practice Address - Street 1:1795 MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1015
Practice Address - Country:US
Practice Address - Phone:413-737-6322
Practice Address - Fax:413-731-9377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAMA105961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery