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DR. SAMUEL YOHANNES RUSSOM DDS
NPI 1144719196
Dentist - Pediatric Dentistry in Chula Vista, CA

Active since May 04, 2018
2015 BIRCH RD STE 103, CHULA VISTA, CA 91915(619) 391-9287 Get Directions Write a Review

NPPES record last updated: December 28, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 28, 2021, Dec 21, 2021, May 4, 2018 (3 updates tracked since 2018).

About Dr. Samuel Yohannes Russom Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SAMUEL YOHANNES RUSSOM DDS (NPI 1144719196) is an individual pediatric dentistry provider in Chula Vista, California, licensed in California (DDS104651) and active in the NPI registry since May 2018.

NPPES Registry Identity

NPI1144719196
Entity TypeIndividualMale
Primary Taxonomy1223P0221X
Provider Legal NameDR. SAMUEL YOHANNES RUSSOMCredential: DDS
Location Address2015 BIRCH RD STE 103Chula Vista, CA 91915-2003
Mailing Address5311 Oak Park DrSan Diego, CA 92105-4959 · (619) 263-0384
Phone(619) 391-9287
Sole ProprietorYes
Enumeration DateMay 4, 2018
Last NPPES UpdateDecember 28, 20213 updates tracked since enumeration
NPPES CertifiedDecember 28, 2021
✔ NPI 1144719196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
License✔ Licensed in CA · DDS104651
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
2015 BIRCH RD STE 103, Chula Vista, CA 91915
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

C PHAM & S MAUSETH DENTAL CORPORATION
Dentist (Orthodontics and Dentofacial Orthopedics)
2015 BIRCH RD STE 103
CHULA VISTA, CA 91915
San Diego County (619) 391-9287

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Russom's NPI number?

The NPI number for Samuel Russom is 1144719196. It was assigned to this individual provider in the NPPES registry on May 4, 2018.

Where is Samuel Russom located?

Samuel Russom practices at 2015 Birch Rd Ste 103, Chula Vista, CA 91915. The listed phone number is (619) 391-9287.

What is Samuel Russom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

What insurance does Samuel Russom accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Samuel Russom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samuel Russom was last updated on December 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.