Provider Demographics
NPI:1962788802
Name:SAMPSON DENTISTRY INC
Entity type:Organization
Organization Name:SAMPSON DENTISTRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:COUSINO
Authorized Official - Last Name:STANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-879-9000
Mailing Address - Street 1:1340 US HIGHWAY 42 NE
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-8516
Mailing Address - Country:US
Mailing Address - Phone:614-879-9000
Mailing Address - Fax:614-879-8679
Practice Address - Street 1:1340 US HIGHWAY 42 NE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-8516
Practice Address - Country:US
Practice Address - Phone:614-879-9000
Practice Address - Fax:614-879-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0197031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty