Alvin Reginald Samuels Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9444378.9921 Issued in UT

Practice address

554 Keily Street
Bureau of Med and Surg - CCPD
Jacksonville, FL 32212

Phone

(757) 953-0000

NPI assigned

Jun 18, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

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

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

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434585600000",
    "number": "1992187637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "554 KEILY STREET",
            "address_2": "BUREAU OF MED AND SURG - CCPD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32212",
            "telephone_number": "757-953-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554 KEILY STREET",
            "address_2": "BUREAU OF MED AND SURG - CCPD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32212",
            "telephone_number": "757-953-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "ALVIN",
        "middle_name": "REGINALD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-18",
        "last_updated": "2015-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "9444378.9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashleigh J Samuel
• Ashley Samuel, DPT
• Florence Gwendolyn Samuel
• John Samuelraj, OTR
• Renee Samuels Laurent, APRN, PMHNP-BC
• Harricia Samuels
• Kaaliyah Samuels
• Sonya N Samuels, L.M.T.
• Hazem Mahmoud Samy, MD
• San Jose Aspen PLLC

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; 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.