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Deactivated NPI 1700090883 Deactivated / Inactive NPI Male Practitioner

Dr. Kim E Samuelson , DMD

Dentist - General Practice • Centerville, UT

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kim Samuelson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date May 09, 2007
NPI Deactivation Date July 31, 2024
Total Practice Duration ~17 Years of Practice (2007 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Kim Samuelson, DMD was a registered Dentist - General Practice practicing in Centerville, UT. Throughout an active medical career spanning 17 years, Dr. Samuelson provided care at the practice location at 80 S MAIN ST until profile deactivation on 2024-07-31.

Practice Location & Contact Primary Location

Practice Address

80 S Main St

Centerville, UT 840141817

Telephone 8012926995
Fax 8012924641

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Centerville, UT

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 22.8 Yrs
Regional Practice Density
9 Specialists

Practicing in Centerville, UT (1388 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License UT 138007

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Kylie Platz , RDH

Dental Hygienist

NPI 1871001438

Registered Dental Hygienist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 31, 2024

Record deactivated on July 31, 2024

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 80 S MAIN ST, CENTERVILLE, UT 840141817 (Tel: 8012926995)

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Updated Business Mailing Address July 08, 2007

Registered at PO BOX 1288, CENTERVILLE, UT 840145288 (Tel: 8012926995)

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Provider Name / Credentials Updated July 08, 2007

Recorded as KIM SAMUELSON, D.M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #138007 in UT)

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Initial NPI Registration & Enumeration May 09, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1700090883
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 09, 2007
Last Update: July 08, 2007
Deactivation Date: July 31, 2024

Mailing Address

Po Box 1288

Centerville, UT 840145288

Phone: 8012926995

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.