Provider Demographics
NPI:1083486583
Name:DEVLIN, SAMANTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50655 PARSONS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1164
Mailing Address - Country:US
Mailing Address - Phone:973-713-7528
Mailing Address - Fax:
Practice Address - Street 1:14736 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2524
Practice Address - Country:US
Practice Address - Phone:313-939-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016016421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice