Provider Demographics
NPI:1396486841
Name:ANDERSON-SAMIN, EMARSHARAE (DMD)
Entity type:Individual
Prefix:
First Name:EMARSHARAE
Middle Name:
Last Name:ANDERSON-SAMIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1126
Mailing Address - Country:US
Mailing Address - Phone:315-635-3671
Mailing Address - Fax:
Practice Address - Street 1:30 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1126
Practice Address - Country:US
Practice Address - Phone:315-635-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist