Active NPI
Kishore Sama, BDS, MSD.
- Periodontics
- Austin, TX
National Provider Identifier
1760798979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 28488
- Practice address
- 1110 W William Cannon Dr Ste 401
Austin, TX 78745-5498 - Phone
- (512) 445-5811
- NPI assigned
- Aug 25, 2010
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 28488 | TX | Primary |
Addresses
Primary practice location
1110 W William Cannon Dr Ste 401
Austin, TX 78745-5498
Mailing address
1110 W William Cannon Dr
Ste 401
Austin, TX 78745-5468
Phone (512) 445-5811
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 |
|---|---|---|---|
| 28488 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424649600000",
"number": "1760798979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1110 W WILLIAM CANNON DR",
"address_2": "STE 401",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787455468",
"telephone_number": "512-445-5811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 W WILLIAM CANNON DR STE 401",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787455498",
"telephone_number": "512-445-5811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMA",
"first_name": "KISHORE",
"name_prefix": "Dr.",
"credential": "BDS, MSD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-25",
"last_updated": "2015-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "28488",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.