Provider Demographics
NPI:1790111052
Name:KLIPP, SAMANTHA (DDS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KLIPP
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 1:526 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2933
Mailing Address - Country:US
Mailing Address - Phone:734-241-5254
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:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist