Provider Demographics
NPI:1558937136
Name:SAMPSELL, TY ANTHONY
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:ANTHONY
Last Name:SAMPSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1918
Mailing Address - Country:US
Mailing Address - Phone:570-412-4652
Mailing Address - Fax:
Practice Address - Street 1:218 S MAPLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3200
Practice Address - Country:US
Practice Address - Phone:724-204-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist