Provider Demographics
NPI:1609657824
Name:MCDERMOTT, SAMANTHA (RDHAP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 WILD LILAC CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8710
Mailing Address - Country:US
Mailing Address - Phone:916-807-8478
Mailing Address - Fax:
Practice Address - Street 1:9247 WILD LILAC CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-8710
Practice Address - Country:US
Practice Address - Phone:916-807-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist