Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 014983 | MO |
NPI | 1033294970 |
---|---|
Provider Name | Dr. Alvin Raye Sams |
First Address | Florissant, MO 63034-2825 |
Second Address | Florissant, MO 63034-2825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |