Provider Demographics
NPI:1528638319
Name:LANDIN SAMPER, GRETHEL
Entity type:Individual
Prefix:
First Name:GRETHEL
Middle Name:
Last Name:LANDIN SAMPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3577 BRANCH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-6753
Mailing Address - Country:US
Mailing Address - Phone:941-822-1300
Mailing Address - Fax:
Practice Address - Street 1:5425 FRUITVILLE RD UNIT 16
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6418
Practice Address - Country:US
Practice Address - Phone:941-343-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN261361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice