Provider Demographics
NPI:1497278550
Name:SAMSON, MICHELE (RDH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 S RIO GRANDE ST APT 7-200
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8273
Mailing Address - Country:US
Mailing Address - Phone:720-339-7828
Mailing Address - Fax:
Practice Address - Street 1:4590 LOWELL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1364
Practice Address - Country:US
Practice Address - Phone:303-455-8962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000904678124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist