Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 29201 | TX |
N | 1223D0001X | Dental Public Health | 29201 | TX |
N | 1223G0001X | General Practice | 29201 | TX |
N | 213EG0000X | General Practice | 29201 | TX |
NPI | 1568890770 |
---|---|
Provider Name | Dr. Tom Alumkal Samuel |
First Address | Waco, TX 76707-2261 |
Second Address | Waco, TX 76707-2261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2013 |
Last Update Date | 04/02/2016 |