Provider Demographics
NPI:1588132427
Name:SAMS, ANGELA ROSE DELLIA (RDH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSE DELLIA
Last Name:SAMS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 E 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640-7406
Mailing Address - Country:US
Mailing Address - Phone:303-587-0535
Mailing Address - Fax:
Practice Address - Street 1:4243 E 136TH AVE UNIT 348
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-6918
Practice Address - Country:US
Practice Address - Phone:720-274-1380
Practice Address - Fax:720-274-1381
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000906540124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist