Active NPI
David Lee Samuelson, DDS
- General Practice Dentistry
- Lowden, IA
National Provider Identifier
1629154018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5822
- Practice address
- 305 McKinley
Lowden, IA 52255 - Phone
- (563) 941-5381
- Fax
- (563) 941-5318
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5822 | IA | Primary |
Addresses
Primary practice location
305 McKinley
Lowden, IA 52255
Mailing address
305 McKinley
PO Box 306
Lowden, IA 52255
Phone (563) 941-5381
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1075945 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5822 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629154018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 MCKINLEY",
"address_2": "PO BOX 306",
"city": "LOWDEN",
"state": "IA",
"postal_code": "52255",
"telephone_number": "563-941-5381",
"fax_number": "563-941-5318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 MCKINLEY",
"city": "LOWDEN",
"state": "IA",
"postal_code": "52255",
"telephone_number": "563-941-5381",
"fax_number": "563-941-5318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELSON",
"first_name": "DAVID",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "5822",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1075945",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lowden, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.