Provider Demographics
NPI:1447998786
Name:SAMA, SHELBY JUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELBY JUSTIN
Middle Name:
Last Name:SAMA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JUSTIN
Other - Middle Name:
Other - Last Name:SAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:103 BACCALAUREATE BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5925
Mailing Address - Country:US
Mailing Address - Phone:828-551-4133
Mailing Address - Fax:
Practice Address - Street 1:103 BACCALAUREATE BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5925
Practice Address - Country:US
Practice Address - Phone:828-551-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist