Provider Demographics
NPI:1508031303
Name:SAMSE, MARQUITA A (RDH)
Entity Type:Individual
Prefix:MS
First Name:MARQUITA
Middle Name:A
Last Name:SAMSE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W CLAIRMONT AVE
Mailing Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE CLINIC
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-833-6370
Mailing Address - Fax:715-833-6447
Practice Address - Street 1:620 W CLAIRMONT AVE
Practice Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE CLINIC
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-833-6370
Practice Address - Fax:715-833-6447
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9974016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist