Samantha Luise Sackos, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

60195 Issued in NC

Practice address

2258 W Roosevelt Blvd Ste a
Monroe, NC 28110-3090

Phone

(704) 291-7100

Fax

(704) 291-7115

NPI assigned

Mar 22, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hammock, DMD & Lotakis, DDS VIII, PLLC

  • Dentist
  • Charlotte, NC
  • NPI 1457818122
  NPD (past)
• Bobby L. Raygan Jr. DMD PC

  • General Practice Dentistry
  • Hueytown, AL
  • NPI 1104644830
  NPD (past)
• Central Avenue Dentistry LLC

  • Dental Clinic/Center
  • Birmingham, AL
  • NPI 1407504186
  NPD (past)
• Central Dentistry, PC

  • General Practice Dentistry
  • Homewood, AL
  • NPI 1346337557
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700352000000",
    "number": "1043770373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2258 W ROOSEVELT BLVD STE A",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281103090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2258 W ROOSEVELT BLVD STE A",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281103090",
            "telephone_number": "704-291-7100",
            "fax_number": "704-291-7115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2230 Park Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282036664",
            "country_code": "US",
            "telephone_number": "704-527-2440",
            "fax_number": "704-527-2406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SACKOS",
        "first_name": "SAMANTHA",
        "middle_name": "LUISE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-22",
        "last_updated": "2023-11-19",
        "certification_date": "2023-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD5263",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "0006687",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "60195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cindy Honeycutt Russell, OTR/L
• Jessica Woodie Rutledge, NP
• Matthew Ryan
• Madeline Saab
• Alexis Marie Koerner Sabul, LCSWA
• Sahara'S Helping Hands
• Falena Salcedo, LCSW-A
• Logan Denise Saleeby, BCBA
• Arwa Mahmoud Saleh, MA, LPCA, NCC
• Alexandra Taylor Salerno, CCC-SLP

• General Practice Dentistry in Monroe, NC
• Providers in Monroe, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.