Provider Demographics
NPI:1134818453
Name:SMALLEY, SAMANTHA KERPER (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:KERPER
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:ANNE
Other - Last Name:KERPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:615 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2335
Mailing Address - Country:US
Mailing Address - Phone:256-343-6196
Mailing Address - Fax:
Practice Address - Street 1:320 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2010
Practice Address - Country:US
Practice Address - Phone:406-283-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MTDEN-DEN-LIC-26044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program