Provider Demographics
NPI:1629719232
Name:SAMANTHA KLIPP DDS PLC
Entity Type:Organization
Organization Name:SAMANTHA KLIPP DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGE
Authorized Official - Prefix:MR
Authorized Official - First Name:VASANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNASWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-223-7586
Mailing Address - Street 1:546 LARKSPUR ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1163
Mailing Address - Country:US
Mailing Address - Phone:734-277-7650
Mailing Address - Fax:
Practice Address - Street 1:526 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2933
Practice Address - Country:US
Practice Address - Phone:734-241-5254
Practice Address - Fax:734-241-1358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental