James L Samples, D.D.S.
Individual provider
Active NPI
Dentist · Carrollton, MO
NPI 1669430997 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1669430997
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11650 (MO)
- Practice address
- 1411A N Jefferson St
Carrollton, MO 64633-1945
- Phone
- (660) 542-1653
- Fax
- (660) 542-1654
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20160331000273 |
MO |
Order and Referring Only - Oral Surgery
Practitioner - Oral Surgery |
7012214349 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 11650 | MO | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
11650 |
MO |
Yes |
Addresses
Primary practice location
1411A N Jefferson St
Carrollton, MO 64633-1945
Mailing address
122 Walnut Dr
Carrollton, MO 64633-1376
Phone (660) 542-2512
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 05646 01 4 | Other | MO | BCBS |