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DR. SAM JOSEPH POIDMORE D,D,S,
Oral and Maxillofacial Surgery >> Dentist >> Dental ProvidersRegistrant NPI Number: 1316088529
Individual Registrant:DR. SAM JOSEPH POIDMORE D,D,S,
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
18152 PAMELA PL VILLA PARK, CA 92861-2626 US
Tel: 714-921-9662 Fax: 714-921-9667
Tel: 714-921-9662 Fax: 714-921-9667
Contact information for business:
18152 PAMELA PL VILLA PARK, CA 92861-2626 US
Tel: 714-921-9662 Fax: 714-921-9667
Tel: 714-921-9662 Fax: 714-921-9667
Registration Information:
NPI: 1316088529
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223S0112X | Dental Providers Dentist Oral and Maxillofacial Surgery | CA | D-24327 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
