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Individual
SAMANTHA LUISE SACKOS
Active
Individual
SAMANTHA LUISE SACKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0006687
AL
1223G0001X
General Practice Dentistry
Primary
60195
NC
1223G0001X
General Practice Dentistry
DD5263
NM
Other
Enumeration date
03/22/2019
Last updated
11/19/2023
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