Provider Demographics
NPI:1871874313
Name:SAMARKOS AND RODRIGUEZ DMD PA
Entity type:Organization
Organization Name:SAMARKOS AND RODRIGUEZ DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMARKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-4558
Mailing Address - Street 1:105 NW 75TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6666
Mailing Address - Country:US
Mailing Address - Phone:352-331-4558
Mailing Address - Fax:
Practice Address - Street 1:105 NW 75TH ST
Practice Address - Street 2:STE 1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6666
Practice Address - Country:US
Practice Address - Phone:352-331-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12788261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1871703330OtherNATIONAL PROVIDER NUMBER