Provider Demographics
NPI:1881315745
Name:DENARDO, SAMANTHA J (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:J
Last Name:DENARDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:J
Other - Last Name:WHITING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8379 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2903
Mailing Address - Country:US
Mailing Address - Phone:810-777-9963
Mailing Address - Fax:
Practice Address - Street 1:8379 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2903
Practice Address - Country:US
Practice Address - Phone:810-777-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601525122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice