Provider Demographics
NPI:1912098179
Name:SAMPLES, STUART Z (DDS)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:Z
Last Name:SAMPLES
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 1:850 FAIRWAY CHADWICK PLAZA
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601
Mailing Address - Country:US
Mailing Address - Phone:660-646-3802
Mailing Address - Fax:660-646-3887
Practice Address - Street 1:850 FAIRWAY CHADWICK PLAZA
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601
Practice Address - Country:US
Practice Address - Phone:660-646-3802
Practice Address - Fax:660-646-3887
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
35602016OtherBLUE CROSS BLUE SHIELD
MO407272202Medicaid