Provider Demographics
NPI:1790947455
Name:SCHUPP, KRISTEN PAIGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:PAIGE
Last Name:SCHUPP
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 1:3 BYRKIT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1158
Mailing Address - Country:US
Mailing Address - Phone:301-223-7440
Mailing Address - Fax:301-223-4127
Practice Address - Street 1:3 BYRKIT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1158
Practice Address - Country:US
Practice Address - Phone:301-223-7440
Practice Address - Fax:301-223-4127
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice