Active NPI
Samuel S Wakim, D.D.S.
- Dentist
- Clermont, FL
National Provider Identifier
1740331925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN23028
- Practice address
- 1927 S Hwy 27
Clermont, FL 34711 - Phone
- (352) 432-8269
- NPI assigned
- Jan 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 40509 | CA | |
| Dentist | 122300000X | 12011100A | IN | |
| Dentist | 122300000X | 36188 | TX | |
| Dentist | 122300000X | DN23028 | FL | Primary |
Addresses
Primary practice location
1927 S Hwy 27
Clermont, FL 34711
Mailing address
15150 Shonan Gold Dr
Winter Garden, FL 34787-5684
Phone (530) 524-7338
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B40509-01 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171023003058 | FL | Order and Referring Only - Dentist | 2668748476 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36188 | TX | MD | Health Psychologist |
| 40509 | CA | MD | Marriage & Family Therapist |
| 12011100A | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635897600000",
"number": "1740331925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15150 SHONAN GOLD DR",
"city": "WINTER GARDEN",
"state": "FL",
"postal_code": "347875684",
"telephone_number": "530-524-7338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1927 S HWY 27",
"city": "CLERMONT",
"state": "FL",
"postal_code": "34711",
"telephone_number": "352-432-8269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKIM",
"first_name": "SAMUEL",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-15",
"last_updated": "2021-11-03",
"certification_date": "2021-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "40509",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": "12011100A",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "36188",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN23028",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B40509-01",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clermont, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.